Amy Pracilio, Nathan J Wilson, Roxsana Devi Tumanggor, Andrew Cashin
Indonesian nurses' awareness and application of reasonable adjustments when caring for people with intellectual disability and/or autism
International nursing review
highrisk medications like benzodiazepines sedative hypnotics antipsychotics commonly prescribed hospitalized older adults despite guidelines recommending avoidance prior interventions fully addressed physicians make prescribing decisions particularly experiencing stress cognitive overload simulation training may help improve prescribing decisionmaking evaluated overprescribing twoarm pragmatic trial randomized 40 firstyear medical resident physicians ie interns inpatient general medicine services academic medical center either intervention 40minute immersive simulation training control online educational training groups primary outcome number new benzodiazepine sedative hypnotic antipsychotic orders treatmentnave older adults hospitalization secondary outcomes included outcome providers discharged one medications orders related control medications outcomes measured using electronic health record data interns service period 2 weeks outcomes evaluated using generalized estimating equations adjusting clustering total 522 treatmentnave older adult patients included analyses followup interns prescribed 1 highrisk medication 13 49 intervention patients 13 50 control patients intervention led difference number new prescriptions rate ratio rr 085 95ci 031235 versus control difference secondary outcomes secondary analyses intervention interns wrote significantly fewer asneeded prn order types highrisk medications rr 029 95ci 008099 instead tended write onetime orders control interns though difference statistically significant rr 220 95ci 060799 although simulation intervention impact total highrisk prescribing hospitalized older adults influence interns prescribed resulting fewer prn orders suggesting possibly greater ownership care future interventions consider insight implementation lessons raised clinicaltrialsgovnct04668248