Reducing psychotropic drug use in nursing homes in Belgium : an implementation study for the roll-out of a practice improvement initiative

Background and Objective: Psychotropic drug use is high in nursing homes in Belgium. A practice improvement initiative (including education, professional support and the transition towards person-centred care) achieved significant reductions in psychotropic drug use. The initiative outline was transcribed into a general intervention template, and consequently implemented in five nursing homes (in mixed locations and with a mixed character) in preparation for a future broader roll-out in Belgium. The impact of the intervention on the use of psychotropic drugs in these five nursing homes is reported in this paper. Methods: The general intervention template was fitted into the individual nursing home setting. Education for the nursing home personnel on psychotropic drugs and non-pharmacological alternatives, as well as details for a transition to person-centred care was provided. Psychotropic drug use was recorded using a dynamic cohort study design with cross-sectional observations (November 2016-November 2017). Results: At baseline, participants' (n = 677) mean age was 85.6 years (range 54-109 years), with 72.6% female. Mean medication intake was 8.5 (range 1-22), predominantly central nervous system drugs (Anatomic Therapeutic Chemical classification N, 88.8%). Long-term (> 3 months) psychotropic drug use (62.0%) and concomitant psychotropic drug use (31.5% taking two or more medications) were high. After 12 months, the prevalence of long-term psychotropic drug use decreased significantly (from 62.0 to 52.9%, p < 0.001), likewise the combined use of psychotropic drugs (from 31.5 to 24.0%, p = 0.001). The decrease in the prevalence of antidepressant and hypnosedative use was significant (respectively, from 32.2 to 23.4%, p < 0.001, and from 35.3 to 28.7%, p = 0.006) in contrast to antipsychotic use (from 17.1 to 15.9%, p = 0.522). Conclusions: The stand-alone adaptation of the previously reported initiative using a general template was possible. This intervention resulted in a significant decrease in psychotropic drug use (predominantly hypnosedatives and antidepressants) among nursing home residents after 12 months

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 (n respondents = 550) and the test-retest procedure for reliability (n respondents = 42). Internal consistency and item analysis were determined. Results: The psychotropic education and knowledge test for nurses in nursing homes (PEAK-NH) (n items = 19) demonstrated reliability (k = 0.641) and internal consistency (Cronbach’s alpha = 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 (n items = 15) and well-functioning discriminators (n items = 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

Industrialisatie en prefabricatie van metselwerk

Probleemstelling: 1) Steeds meer bedrijven en organisaties krijgen te kampen met een tekort aan arbeidskrachten in de bouwsector. Industrialisatie in het bouwproces is dan ook meer dan welkom, en worden op verschillende methodes en manieren geïntroduceerd in het bouwproces. Uiteraard hebben deze vernieuwingen, naast hun vele voordelen, ook een aantal nadelen, specifiek voor iedere methode. 2) Met de verschillende systemen in het achterhoofd gaat deze thesis nog even dieper in op het principe van de Metselfabriek. Is het mogelijk dit systeem nog verder te laten evolueren/industrialiseren? Doel: 1) Om het bos nog door de bomen te zien, zou ik voor de toekomstige bouwheer een overzicht willen bieden welke systemen er nu allemaal op de markt aanwezig zijn, en welke consequenties eraan vasthangen. Hij zou in een aantal minuten moeten kunnen uitmaken welke systemen er al onmiddellijk uit de boot vallen, en welke systemen eventueel van toepassing zouden kunnen zijn. Deze systemen worden zowel constructief als bouwfysisch bekeken. 2) Er wordt nagegaan welke verdere evolutie er nog mogelijk is in de industrialisatie van dit systeem, en welke gevolgen dit zou kunnen hebben. Werkwijze: 1) Allerhande verschillende systemen worden naast elkaar gezet, en op verschillende vlakken vergeleken met elkaar. Hierna wordt in een aantal bladzijden een kort en bondig overzicht gegeven. 2) Een aantal aspecten uit dit bouwproces worden onder de loep genomen, en gezocht of, met de andere systemen in het achterhoofd, deze voor verbetering vatbaar zijn

"roles" in the bachelor's and master's programmes in engineering technology: Definitions and corresponding learning outcomes

This study aimed to identify the different professional roles for engineers and the corresponding learning outcomes. Interviews with HR-managers of companies working with engineers resulted in the identification of three main roles, namely: operational excellence (an engineer that organises and optimises processes), product leadership (an engineer that develops new products/technologies) and customer intimacy (an engineer that provides solutions according to the needs of the customer). A survey with company representatives showed that for an operational excellence engineer, problem analysing and solving skills are considered the most essential skills. For an engineer in product leadership, the design and development skills are found significantly more important. At last, for customer intimacy it was less clear. However, professionalism, communication, entrepreneurship and ethic responsibility were found to be more important for a customer intimacy engineer than for a product leadership engineer. Basic scientific knowledge was found to be of lower importance for a customer intimacy engineer. It is important keep in mind that this story is not as black and white as may be concluded from this study. Often, engineers do not function in one specific 'role' during their professional life: They combine roles within one function or they change roles in the course of their career. This research was a first step in the exploration of roles for engineers and the implementation of these roles in the study programme. To increase our further understanding of the results, our next step is to research the disciplinary future self-images of the students in context of the different professional roles. In the near future we will study how we can include these results in the engineering programmes. It is our goal to face all students, even so the freshmen, with this reality. It is important that we make them aware of their gifts and how these gifts can be developed to become an engineer fitting perfectly with their ideal future self. A well-informed view of the future professional roles could help students in directing their individual development of competences.status: publishe

Een kwalitatieve exploratie van het chronisch gebruik van psychofarmaca in woonzorgcentra

Summary Background Behavioural problems are present in up to 90% of patients with dementia. Guidelines advise a non-pharmacological approach as first-line treatment and advise against the chronic use of psychotropic drugs. In Belgian nursing homes, the chronic use of psychotropics remains an important problem. Goal To explore the reasons for initiation, continuation and cessation of psychotropic drug treatment in elderly with dementia and behavioural problems, residing in the nursing home. Method A qualitative research based on 27 semi-structured interviews, analysed by using ’The Qualitative Analysis Guide of Leuven (QUAGOL)’, performed by three independent researchers. Results Seventeen codes were developed for four themes: (1) to initiate, to continue or to cessate?; (2) Behaviour; (3) Therapy; and (4) Alternatives. The main reasons for initiating psychotropic drugs were reducing disruptive behavior and improving the quality of life of the resident. A comparison between the interviewed showed that psychotropic drugs were often initiated at the request of the nursing staff. Neither the doctor nor the nurses considered the monitoring of the drug therapy their task, and tended to shift the responsibility. Once psychotropics were started, the treatment was often chronic but remained part of a dynamic process where balance was sought between risks/benefits. More insights into the behavior of the resident led to a better treatment of the behavioral problems. Conclusion The chronic use of psychotropic drugs in Belgian nursing homes is part of a dynamic process where doctors and nurses try to find a balance between risks and benefits. Nurses play an important role while physicians can take a more active role in the process of indication and monitoring of psychopharmaceuticals. Discontinuation of psychotropic drugs and the use of non-pharmacological alternatives are important bottlenecks in nursing homes. Education and training, updated practice guidelines, appropriate research, professionalization and management elements can, in a complex interaction, change the situation. Mesh terms Dementia, Long-Term Care, Nursing Homes, Antidepressive Agents, Antipsychotic agents, Behavioral Symptomsstatus: publishe