Format

Send to

Choose Destination
Int Psychogeriatr. 2019 Oct 22:1-10. doi: 10.1017/S104161021900111X. [Epub ahead of print]

The "CHROME criteria": Tool to optimize and audit prescription quality of psychotropic medications in institutionalized people with dementia.

Author information

1
Maria Wolff Foundation, Madrid, Spain.
2
Universidad de la Laguna, Sta Cruz de Tenerife, Spain.
3
Centro Sociosanitario El Pino, Instituto de Atención Social y Sociosanitaria (IAS), Las Palmas de Gran Canaria, Spain.
4
Servicio de Farmacia, Hospital Universitario San Agustín, Avilés, Spain.
5
Servicio de Psiquiatría, Hospital Universitario 12 de Octubre, Madrid, Spain.
6
Clínica Padre Menni, Hermanas Hospitalarias, Pamplona, Spain.
7
Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Abstract

OBJECTIVE:

Describe and validate the CHROME (CHemical Restraints avOidance MEthodology) criteria.

DESIGN:

Observational prospective longitudinal study.

SETTING:

Single nursing home in Las Palmas de Gran Canaria, Spain.

PARTICIPANTS:

288 residents; mean age: 81.6 (SD 10.6). 77.4% had dementia.

INTERVENTION:

Multicomponent training and consultancy program to eliminate physical and chemical restraints and promote overall quality care. Clinicians were trained in stringent diagnostic criteria of neuropsychiatric syndromes and adequate psychotropic prescription.

MEASUREMENTS:

Psychotropic prescription (primary study target), neuropsychiatric syndromes, physical restraints, falls, and emergency room visits were semi-annually collected from December 2015 to December 2017. Results are presented for all residents and for those who had dementia and participated in the five study waves (completer analysis, n=107).

RESULTS:

For the study completers, atypical neuroleptic prescription dropped from 42.7% to 18.7%, long half-life benzodiazepines dropped from 25.2% to 6.5%, and hypnotic medications from 47.7% to 12.1% (p<0.0005). Any kind of fall evolved from 67.3 to 32.7 (number of falls by 100 residents per year). Physicians' diagnostic confidence increased, while the frequency of diagnoses of neuropsychiatric syndromes decreased (p<0.0005).

CONCLUSIONS:

Implementing the CHROME criteria reduced the prescription of the most dangerous medications in institutionalized people with dementia. Two independent audits found no physical or chemical restraint and confirmed prescription quality of psychotropic drugs. Adequate diagnosis and independent audits appear to be the keys to help and motivate professionals to optimize and reduce the use of psychotropic medication. The CHROME criteria unify, in a single compendium, neuropsychiatric diagnostic criteria, prescription guidelines, independent audit methodology, and minimum legal standards. These criteria can be easily adapted to other countries.

KEYWORDS:

Chemical restraint; Dementia; Neuropsychiatric symptoms; Non-pharmacological therapies; Nursing home; Pharmacological restraint; Pharmacological treatment; Psychotropic medication

PMID:
31635561
DOI:
10.1017/S104161021900111X

Supplemental Content

Full text links

Icon for Cambridge University Press
Loading ...
Support Center