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Nurse Staffing and Nursing Home Deficiency of Care for Inappropriate Psychotropics Use in Residents With Dementia

机译:护士人员配备和护理家庭缺乏护理不适合患有痴呆症的居民的精神药物

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摘要

Psychotropics use to manage behavioral and psychological symptoms of dementia (BPSD) in nursing homes (NHs) has been the focus of policy attention due to their adverse effects. We hypothesized that NHs with lower nursing staffing would have greater reliance on psychotropics use to control BPSD. A NH deficiency of care can be cited for inappropriate psychotropics use (F-tag 758). The association between the occurrence of F-758 tags and nurse staffing in residents with dementia was examined using the 2017-18 Certification and Survey Provider Enhanced Reporting data (n=14,548 NHs). Staffing measures included nursing hours per resident day (HPRD) and registered nurse (RN) skill-mix. Generalized linear mixed models that included covariates (NH location, bed size, ownership, proportion of residents with dementia/depression/psychiatric disorders and with Medicare/Medicaid) estimated the magnitude of the associations. There were 1,872 NHs with F-758 tags indicating inappropriate psychotropics use for NH residents with dementia. NHs with greater RN and certified nurse assistant (CNA) HPRD had significantly lower odds of F-758 tags (OR=0.59 54, 95% CI=0.47 44-0.73 66; OR=0.87, 95% CI=0.77-0.99, respectively) and similar findings were found in NHs with greater RN skill-mix (OR=0.14 10, 95% CI=0.05 04-0.37 25). There were no significant associations between the occurrence of F-758 tags and licensed practice nurse and unlicensed nurse aide HPRD. This study found that RN and CNA staffing had inverse associations with inappropriate psychotropic use citations among residents with dementia. NHs with higher RN staffing ratios may be better able to implement alternatives to pharmacological approaches for BPSD. It is suggested that NHs be equipped with adequate nurse staffing levels to reduce unnecessary psychotropics use.
机译:精神药物用于管理痴呆症的行为和心理症状(BPSD)在护理家庭(NHS)是由于其不利影响导致的政策注意力。我们假设具有较低护理人员的NHS将更依赖于机理使用来控制BPSD。可以引用NH缺乏护理,以便不适当的精神药物使用(F-Tag 758)。使用2017-18认证和调查提供商增强了报告数据(N = 14,548 NHS),研究了F-758标签和护士在患有痴呆症的居民的居民的职员的关联。人员配置措施包括每个居民日(HPRD)和注册护士(RN)技能组合的护理时间。包括协变量(NH位置,床大小,所有权,患有痴呆/抑郁/精神疾病以及Medicare / Medicatod的居民比例的广义线性混合模型估计了协会的大小。有1,872 nHS与F-758标签,表明NH居民使用痴呆症的不当的精神药物。具有更高的RN和认证护士助理(CNA)HPRD的NHS具有显着较低的F-758标签(或= 0.59 54,95%CI = 0.47 44-0.73 66;或= 0.87,95%CI = 0.77-0.99 )在NHS中发现了类似的结果,具有更高的RN技能 - 混合物(或= 0.14 10,95%CI = 0.05 04-0.37 25)。 F-758标签的发生与许可的实践护士和未许可护士助手HPRD之间没有重大协会。该研究发现,RN和CNA人员配备逆关联与患有痴呆症的居民之间不适当的精神药物。 RN较高人员指比的NHS可能更好地能够实施BPSD的药理学方法的替代品。建议NHS配备了足够的护士人员配置水平,以减少不必要的精神药物使用。

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