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Rationalising Antipsychotic Prescribing in Dementia (RAPID) complex intervention: A mixed-methods feasibility
Kieran A Walsh1,2,3, Stephen Byrne2, Alex O'Riordan2
1Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
Exploratory Research in Clinical and Social Pharmacy
|October 24, 2022
Summary
The Rationalising Antipsychotic Prescribing in Dementia (RAPID) intervention showed feasibility in nursing homes, reducing antipsychotic use in dementia residents. Further modifications are needed for larger studies.
Area of Science:
- Geriatric Medicine
- Psychopharmacology
- Nursing Home Care
Background:
- Inappropriate antipsychotic prescribing is a concern for nursing home residents with dementia.
- The Rationalising Antipsychotic Prescribing in Dementia (RAPID) intervention was developed to address this issue.
- RAPID includes staff education, academic detailing, and a resident assessment tool.
Purpose of the Study:
- To assess the feasibility and acceptability of the RAPID intervention in a nursing home.
- To examine trends in psychotropic prescribing, falls, and behavioral symptoms associated with the intervention.
Main Methods:
- A mixed-methods feasibility study was conducted in an Irish nursing home (07/2017-01/2018).
- Included staff/GP education, academic detailing, and a resident assessment tool.
- Data collection involved focus groups, interviews, pre/post evaluations, and prescribing rate analysis.
Main Results:
- Staff training had 21% attendance; GP detailing had 100% attendance.
- Participants found training beneficial, but resident assessment tool usage was limited.
- Regular antipsychotic use in dementia residents decreased from 44% to 36%; PRN psychotropic use significantly reduced.
Conclusions:
- The RAPID intervention appears feasible and acceptable for nursing home settings.
- Protocol modifications and further research are necessary before large-scale evaluation.
- The intervention shows potential for reducing antipsychotic and psychotropic medication in dementia care.
Keywords:
ABC, Antecedent-Behaviour-ConsequenceAntipsychoticsBCW, behaviour change wheelBPSD, behavioural and psychological symptoms of dementiaCNM, clinical nurse managerCOS, core outcome setCPZ, chlorpromazineDementiaFeasibility studyGP, general practitionerGRAMMS, Good Reporting of A Mixed-Methods StudyHCA, healthcare assistantInappropriate prescribingLong term care facilityMRC, Medical Research CouncilNIHR, National Institute for Health ResearchNPI-NH, neuropsychiatric inventory - nursing home versionNursing homeOD, occupational disruptivenessPINCH-ME, Pain, Infection, Nutrition, Constipation, Hydration, Medication and EnvironmentPRN, pro re nataQUM-D, quality use of medicines in dementiaRAPID, Rationalising Antipsychotic Prescribing in DementiaWHO-ATC, World Health Organization Anatomical Therapeutic ChemicalMore Related Videos
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