Karen Versluys

The psychotropic education and knowledge test for nurses in nursing homes: Striving for PEAK performance

Objectives: The psychotropic education and knowledge test for nurses in acute geriatric care (PEAK-AC) measures knowledge of psychotropic indications, doses and adverse drug reactions in older inpatients. Given the low internal consistency and poor discrimination of certain items, this study aims to adapt the PEAK-AC, validate it in the nursing home setting and identify factors related to nurses’ knowledge of psychotropics. Method: This study included nurses and nurse assistants employed by nursing homes (n = 13) and nursing students at educational institutions (n = 5) in Belgium. A Delphi technique was used to establish content validity, the known groups technique for construct validity (nrespondents = 550) and the test–retest procedure for reliability (nrespondents = 42). Internal consistency and item analysis were determined. Results: The psychotropic education and knowledge test for nurses in nursing homes (PEAK-NH) (nitems = 19) demonstrated reliability (κ = 0.641) and internal consistency (Cronbachs α = 0.773). Significant differences between-group median scores were observed by function (p < 0.001), gender (p = 0.019), educational background (p < 0.001), work experience (p = 0.008) and continuing education (p < 0.001) for depression, delirium and pharmacotherapy topics. Items were acceptably difficult (nitems = 15) and well-functioning discriminators (nitems = 17). Median PEAK-NH score was 9/19 points (interquartile range 6–11 points). Respondents’ own estimated knowledge was related to their PEAK-NH performance (p < 0.001). Conclusion: The PEAK-NH is a valid and reliable instrument to measure nurses’ knowledge of psychotropics. These results suggest that nurses have limited knowledge of psychotropic use in nursing homes and are aware of their knowledge deficits. The PEAK-NH enables educational initiatives to be targeted and their impact on nurses’ knowledge to be tracked.

A Typology of Interprofessional Teamwork in Acute Geriatric Care: A Study in 55 units in Belgium

To explore the quality of interprofessional teamwork in acute geriatric care and to build a model of team types.

Terminal Care in Older Patients in Hospital: Development of a Quality Indicator Set and its First Application in a Retrospective Comparison of Patients Treated in an Acute Geriatric Unit and a Palliative Care Unit of a Belgian University Hospital

Background: Care at the end-of-life of geriatric inpatients is of increasing importance. Nevertheless, limited research has been conducted on this subject so far. Objectives: To compose a set of quality indicators (QIs) which measure the quality of terminal care for geriatric inpatients and to compare the quality of end-of-life care between the Acute Geriatric Unit (AGU) and the Palliative Care Unit (PCU). Design: Retrospective case study. Setting: Belgian university hospital. Participants: Patients >75 years, who died an expected death between January 1st 2009 and December 31st 2010 at the AGU or the PCU. Measurements: QIs collected through systematic literature search and the Delphi method. Results: A set of 17 QIs was composed. At the AGU, 58 patients were included (QI score generally varying between 0 and 70%) and at the PCU 59 (QI score generally varying between 50 and 100%). The PCU scored significantly higher for 5 of the 17 QIs: pain screening, oral care and anxiety screening (all p < .001), prescription of rescue medication (p < .01), and pain treatment (p < .05). Both units scored low on delirium screening, spiritual care, and involvement of the general practitioner (GP) in care planning. Conclusion: In-hospital care for the dying geriatric patient could be optimized further. Both departments should pay more attention to delirium screening, spiritual care, and the involvement of the GP in the care planning. At the AGU it is recommended that items regarding pain screening and treatment, oral care, and anxiety screening should routinely be included in the dying patients’ records.

Reply to: Interprofessional Teamwork in Acute Geriatric Care: Where Are the Pharmacists?

1. Piers RD, Versluys KJJ, Devoghel J, Lambrechts S, Vyt A, Van den Noortgate NJ. A typology of interprofessional teamwork in acute geriatric care: A dtudy in 55 units in Belgium. J Am Geriatr Soc 2017;65: 2064–2070. 2. Chisholm-Burns MA, Kim Lee J, Spivey CA et al. US pharmacists’ effect as team members on patient care: Systematic review and meta-analyses. Med Care 2010;48:923–933. 3. Spinewine A, Dhillon S, Mallet L, Tulkens PM, Wilmotte L, Swine C. Implementation of ward-based clinical pharmacy services in Belgium—description of the impact on a geriatric unit. Ann Pharmacother 2006;40:720–728. 4. Chan B, Reeve E, Matthews S et al. Medicine information exchange networks among healthcare professionals and prescribing in geriatric medicine wards. Br J Clin Pharmacol 2017;83:1185–1196. 5. Lee JK, Slack MK, Martin J, Ehrman C, Chisholm-Burns N. Geriatric patient care by U.S. pharmacists in healthcare teams: systematic review and meta-analyses. J Am Geriatr Soc 2013;61:1119–1127. 6. Spinewine A, Swine C, Dhillon S et al. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: A randomized, controlled trial. J Am Geriatr Soc 2007;55:658–665. 7. Steurbaut S, Leemans L, Leysen T et al. Medication history reconciliation by clinical pharmacists in elderly inpatients admitted from home or a nursing home. Ann Pharmacother 2010;44:1596–1603. 8. Somers A, Robays H, De Paepe P, Van Maele G, Perehudoff K, Petrovic M. Evaluation of clinical pharmacist recommendations in the geriatric ward of a Belgian university hospital. Clin Interv Aging 2013;8:703–709. 9. Van der Linden L, Decoutere L, Walgraeve K et al. Combined use of the Rationalization of Home Medication by an Adjusted STOPP in Older Patients (RASP) list and a pharmacist-led medication review in very old inpatients: Impact on quality of prescribing and clinical outcome. Drugs Aging 2017;34:123–133. 10. Baeyens JP. Belgian care programme for older patients. J Nutr Health Aging 2010;14:474–475.