Nursing staffing and state-level dementia training in relation to inappropriate psychotropic medication use In nursing home residents with dementia
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Jung Min Yoon, MSN, RN
- Sigma Affiliation
- Lambda Alpha at-Large
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- University of Maryland, Baltimore, Baltimore, Maryland, USA
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Background: Psychotropics use to manage behavioral symptoms associated with dementia in nursing homes (NHs) has been the focus of policy attention due to their adverse effects. NHs can be flagged for inappropriate psychotropics use as a deficiency of care (F-tag 758). Aim: This study was to examine the occurrence of F-758 citations in relation to NH nurse staffing and state-level NH in-service dementia training requirements. Methods: Certification and Survey Provider Enhanced Reporting data (n=13,318 NHs) from 2017-18 were used. Staffing measures included nursing hours per resident day (HPRD) and registered nurse (RN) skill-mix. State-level in-service NH dementia training was collected from state NH staff training regulations in effect for calendar year 2017. Generalized linear mixed models estimated the magnitude of the associations. Results: 1,872 NHs received F-758 tags related to care of residents with dementia. NHs with greater RN HPRD had significantly lower odds of receiving F-758 tags (OR=0.59, 95% CI=0.47-0.73) and similar findings were found in NHs with greater RN skill-mix (OR=0.14, 95% CI=0.05-0.37). NHs in states specifying training content and hours had significantly lower odds of F-758 tags (OR=0.76, 95% CI=0.60-0.95). Among NHs with lower RN HPRD, those in states regulating training content and hours had significantly lower odds of F-758 tags (OR=0.67, 95% CI=0.48-0.94), with similar findings among NHs with lower certified nurse assistant HPRD (OR=0.69, 95% CI=0.51-0.91). In NHs without SCUs, training with specific content and hours was inversely related to F-758 tags compared to those with SCUs (OR=0.57, 95% CI=0.34-0.96). Conclusion: NHs need to be equipped with adequate RN staffing levels to reduce unnecessary psychotropics use. States should develop more comprehensive, robust dementia care training regulations for NH nursing staff. Required dementia-specific in-service training may be more helpful in facilities with lower staffing and/or lacking an SCU.
Jung Min Yoon is a 2018/2019 Sigma Small Grant Recipient.
The Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the Sigma grant. No further peer-review has taken place upon the completion of the Sigma grant final report and its appearance in this repository.
Type | Report |
Acquisition | Self-submission |
Review Type | None: Sigma Grant Recipient Report |
Format | Text-based Document |
Evidence Level | Cross-Sectional |
Research Approach | Quantitative Research |
Keywords | Dementia; Psychotropic Medication; Deficiency of Care; Nursing Home; Nurse Staffing; In-service Nursing Home Dementia Training |
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