TY - JOUR
T1 - Factors associated with the decision to prescribe and administer antipsychotics for older people with delirium
T2 - A qualitative descriptive study
AU - Tomlinson, Emily J.
AU - Rawson, Helen
AU - Manias, Elizabeth
AU - Phillips, Nicole Nikki M.
AU - Darzins, Peteris
AU - Hutchinson, Alison M.
N1 - Funding Information:
Funding This work was supported by a Career Continuity for Researchers who are Primary Carers research grant for the chief investigator from Deakin University.
Publisher Copyright:
©
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - Objectives To explore factors associated with decision-making of nurses and doctors in prescribing and administering as required antipsychotic medications to older people with delirium. Design Qualitative descriptive. Setting Two acute care hospital organisations in Melbourne, Australia. Participants Nurses and doctors were invited to participate. Semi-structured focus groups and individual interviews were conducted between May 2019 and March 2020. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. Results Participants were 42 health professionals; n=25 nurses and n=17 doctors. Themes relating to decisions to use antipsychotic medication were: safety; a last resort; nursing workload; a dilemma to medicate; and anticipating worsening behaviours. Nurses and doctors described experiencing pressures when trying to manage hyperactive behaviours. Safety was a major concern leading to the decision to use antipsychotics. Antipsychotics were often used as chemical restraints to â € sedate' a patient with delirium because nurses â € can't do their job'. Results also indicated that nurses had influence over doctors' decisions despite nurses being unaware of this influence. Health professionals' descriptions are illustrated in a decision-making flowchart that identifies how nurses and doctors navigated decisions regarding prescription and administration of antipsychotic medications. Conclusions The decision to prescribe and administer antipsychotic medications for people with delirium is complex as nurses and doctors must navigate multiple factors before making the decision. Collaborative support and multidisciplinary teamwork are required by both nurses and doctors to optimally care for people with delirium. Decision-making support for nurses and doctors may also help to navigate the multiple factors that influence the decision to prescribe antipsychotics.
AB - Objectives To explore factors associated with decision-making of nurses and doctors in prescribing and administering as required antipsychotic medications to older people with delirium. Design Qualitative descriptive. Setting Two acute care hospital organisations in Melbourne, Australia. Participants Nurses and doctors were invited to participate. Semi-structured focus groups and individual interviews were conducted between May 2019 and March 2020. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. Results Participants were 42 health professionals; n=25 nurses and n=17 doctors. Themes relating to decisions to use antipsychotic medication were: safety; a last resort; nursing workload; a dilemma to medicate; and anticipating worsening behaviours. Nurses and doctors described experiencing pressures when trying to manage hyperactive behaviours. Safety was a major concern leading to the decision to use antipsychotics. Antipsychotics were often used as chemical restraints to â € sedate' a patient with delirium because nurses â € can't do their job'. Results also indicated that nurses had influence over doctors' decisions despite nurses being unaware of this influence. Health professionals' descriptions are illustrated in a decision-making flowchart that identifies how nurses and doctors navigated decisions regarding prescription and administration of antipsychotic medications. Conclusions The decision to prescribe and administer antipsychotic medications for people with delirium is complex as nurses and doctors must navigate multiple factors before making the decision. Collaborative support and multidisciplinary teamwork are required by both nurses and doctors to optimally care for people with delirium. Decision-making support for nurses and doctors may also help to navigate the multiple factors that influence the decision to prescribe antipsychotics.
KW - delirium & cognitive disorders
KW - general medicine (see internal medicine)
KW - geriatric medicine
UR - http://www.scopus.com/inward/record.url?scp=85109640536&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-047247
DO - 10.1136/bmjopen-2020-047247
M3 - Article
C2 - 34233988
AN - SCOPUS:85109640536
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 7
M1 - e047247
ER -