Objectives To establish a medication review programme in geriatric patients in nursing homes. Methods 70 nursing homes, attended by 8 healthcare teams; two consultant pharmacists provide training and support. Prospective study, conducted between August and December 2013, consisting in patients medication profile review, using an algorithm developed by the Pharmacy Department. Drug-related problems (DRP) were communicated to physicians and documented using the Pharmaceutical Care Network Europe scheme. Medication appropriateness index (MAI) score was calculated before and after the pharmacist's interventions.Results Medication profiles of 127 patients (mean age 84 years) were reviewed. 424 DRP were detected, the majority related to potential adverse drug events. Pharmacists' interventions/recommendations were made mainly at prescription level. Lack of indication for the drug prescribed in the clinical record was a recurrent problem, thus indicating a somewhat poor quality in these records. Potentially inappropriate drug prescription was also a common problem (17.6%). Cardiovascular, alimentary tract and metabolism and nervous system drugs were those with more DRP. Degree of acceptance of interventions was 80%. The principal cause of nonacceptance was when the drug has been prescribed by a specialist. Number of drugs per patient dropped from 10.3 to 9.5, and the mean MAI score dropped from 5.4 to 1.3. Conclusions The incorporation of consultant pharmacists at nursing home level has led us to know the quality of prescription and the DRP. We have established a multidisciplinary team that works for the improvement of drug use.
Background Medicines with anticholinergic activity have been linked to a variety of adverse drug reactions in the elderly. PurposeTo determine the anticholinergic burden in revised profiles, and the level of risk. Materials and MethodsThe Prescription Quality Unit (PQU), which is staffed by a doctor, two pharmacists, a nurse and other technical-administrative staff, is integrated into the geriatric care team. The Unit provides care to 6800 residents in 163 centres. The PQU provides training and support to different care teams by reviewing procedures and holding conciliation meetings. The process of rationalisation consists of systematically reviewing medicines plans according to the criteria of efficacy, safety and efficiency. The team suggests modifications in medicines plans and reports to the health care professionals involved. Anticholinergic drugs were selected from the review. These medicines were classified into four groups, according to the anticholinergic potency. Results A prospective study was undertaken during the period June 2011–June 2012: 7,347 patients were reviewed (some in duplicate). 959 patients were identified, and those patients were prescribed 1,984 drugs with anticholinergic activity (mean age 85 years (52–111 years)). In 162 patients, strong anticholinergic activity drugs were found: 62% oral antimuscarinics for urinary incontinence, 33% tricyclic antidepressants, 4% antispasmodics with anticholinergic properties and 1% systemic H1 antihistamines (dexchlorpheniramine); 252 patients with moderate anticholinergic activity drugs (70% paroxetine); 500 patients with mild anticholinergic drugs and 45 patients had drugs whose activity was concentration-dependent. Sixty-eight patients were simultaneously being prescribed more than one medicine with anticholinergic activity (17 patients on strong anticholinergic activity drugs simultaneously). Conclusions Due to the comorbidities and frailty of this population, medicines must be selected individually for each patient, selecting drugs with the lowest level of anticholinergic activity. We observed a group of patients at special risk who were being treated for pathologies related to the urinary tract. No conflict of interest.
Background Optimising drug treatment is an essential part of caring for older people. Due to the comorbidity and frailty of this population, pharmacologic treatment should be individualised and reviewed to ensure the benefits for patients. The involvement of pharmacists through interventions has led to positive outcomes in different settings, although there is not a broad experience in nursing homes. Purpose To optimise pharmacotherapy through pharmaceutical interventions in geriatric patients in nursing homes within a pharmaceutical care programme. Materials and methods In the Prescription Quality Unit (PQU), two pharmacists provide training and support to several care teams in nursing homes. They review clinical reports and medication plans of patients, using an algorithm developed by the pharmacy service of our institution according to criteria of efficacy, safety, efficiency and standards in geriatrics. The problems detected and pharmaceutical interventions are communicated to the physicians in reconciliation meetings. Results A prospective study was undertaken during August and September 2013. Medication plans of 62 patients (mean age 84 years) were reviewed. 211 interventions were made with a 78% acceptance rate by physicians. These interventions were related to: Reconciliation 24% Drug omission 19% Drug not indicated 15% Drug inappropriate in geriatrics 15% Dosage error 7% Duplication 6% Contraindication 5% Low intrinsic value drugs 2% Length of treatment 1% In the 22% of the interventions not accepted, the main reasons were: specialist follow-up, the change had been already made unsuccessfully, to prioritise the stability of the patient over the recommendation. Conclusions There is a high incidence of medicines problems in nursing homes. The work of pharmacists has a high value in improving drug use in these settings. In parallel, it encourages communication and collaboration between professionals. No conflict of interest.
Background Osteoporosis is associated with significant morbidity and mortality. Oral bisphosphonates have become a mainstay of treatment, but concerns have emerged that long-term use of these drugs may suppress bone remodelling, leading to unusual fractures. PurposeTo assess the intervention on bisphosphonates prescribing of institutionalised geriatric residential centres, by the Prescription Quality Unit (PQU). Materials and MethodsThe PQU cheques that bisphosphonate treatment is based on patient age, duration of treatment, fracture, concomitant medicines and bisphosphonate prescribed. The PQU reviews the patients’ medicines plans. The results of the review are communicated to the respective physicians, who analyse and discuss the medicines plans on the PQU report. The PQU performs regular clinical sessions and provides the doctors with drug data information (alerts, newsletters, surveys) involved in prescription reviews. ResultsInterventions in bisphosphonates prescriptions from June 2011 to June 2012: 383 interventions were made (3.7% of all interventions) and 86 were accepted, 22.4% on the bisphosphonates.In 2011 one was accepted (19.11%) while in 2012 27.2% were accepted.The mean age of patients with bisphosphonates was 86 years (10.63% male and 89.37% female).Bisphosphonates represented 4.1% of total prescriptions.The breakdown of bisphosphonates prescriptions was 75.4% alendronate, 4.3% alendronate/cholecalciferol combination, 5.6% ibandronic acid and 14.61% risedronic acid. Conclusions The intervention in bisphosphonates prescribing has been much more effective in 2012 than in 2011 and more intensive updates and drug date information has been provided to physicians in this period. There were no problems in the use of the recommended bisphosphonate, alendronate. No conflict of interest.
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