A study of the appropriateness of prescribing in nursing homes

Abstract

A study carried out in five nursing homes and 13 general practitioner practices in the North West National Health Service region investigated medicine use in the homes and assessed the extent of inappropriate prescribing using consensus derived criteria. A review of the medical and nursing records of 101 residents showed that they were using a total of 714 items (mean 7.1; range 0 to 15), of which 659 were medicines, including 51 dressings, and 55 were other items such as stoma products. When criteria for inappropriate prescribing were developed and applied, 54 (53 per cent) residents were judged to have one or more inappropriate prescriptions. Medicines most frequently associated with inappropriate prescribing were those for the cardiovascular system (57 per cent of inappropriate prescriptions) and the central nervous system (17 per cent); diuretics accounted for 41 per cent of all inappropriate prescriptions. However, these results may not be representative of the true level of inappropriate prescribing. Of the eight GPs who filled in a questionnaire, five had a system for regularly reviewing drug treatment for nursing home residents; all considered that nursing home residents could benefit if pharmacists were to support GPs by offering advice about individual residents' drug treatment. Elderly residents in nursing homes are at high risk of inappropriate prescribing. A role for pharmacists in the monitoring of individual residents' prescriptions, in academic detailing or in guideline development could help in improving the quality of prescribing for nursing home residents.

Medication use in nursing homes for elderly people

“…These values are lower than that for residents in the USA, where the mean is six to seven drugs per patient (Beers et al, 1992). The USA ®gure is similar to the UK, where residents in Northamptonshire nursing homes took a mean of 6.6 drugs (range 1±19) (Corbett, 1997) and residents in the North West region took 6.5 drugs (range 0±14) (Lunn et al, 1997). Nolan and O'Malley (1989) quote diuretics, analgesics, potassium salts, cardiac glycosides and laxatives as the most commonly prescribed nonpsychotropic drugs and this is similar to the most common non-psychotropic drugs prescribed in North and West Belfast (Passmore et al, 1995).…”

“…In the UK there are relatively few data on use of psychotropic drugs in nursing homes. Lunn et al (1997) describe 26% of their population as using`central nervous system' drugs as de®ned in the British National Formulary, although this grouping includes antiepileptics and analgesics. Snowdon et al (1995) showed psychotropic drug use to be 59% in central Sydney nursing homes.…”

Prescribing Indicators for Evaluating Drug Use in Nursing Homes

“…In 1997, Lunn et al 7 developed a set of 18 explicit criteria, based on expert opinion, to identify inappropriate prescribing in 101 nursing home residents in the UK. For 7 of the 18 criteria, information on clinical status or diagnoses of the residents was necessary, again making them unsuitable for use with pharmacy prescription data only, although some of them could be incorporated.…”

Use of medicines in nursing homes for older people

“…In England, Lunn et al (1997) describe 26% of their population to be using 'central nervous system' drugs as defined by the British National Formulary (BNF; British Medical Association & Royal Pharmaceutical Society of Great Britain, 2002), but this definition includes anti-epileptics and analgesics. In 1995, Snowdon et al reported that psychotropic drug use in Australian nursing homes was 59%, although this figure has fallen in recent years (Snowdon, 1999).…”

“…In a study carried out in England, a physician (in elderly care), a general practitioner (GP), a pharmacist and a clinical pharmacologist developed criteria for inappropriate prescribing and these were then applied to the medication regimes of 101 residents (Beers et al, 1992). It was found that 53% of residents had at least one inappropriate prescription, with cardiovascular and central nervous system drugs being implicated most often (Lunn et al, 1997).…”