A Model for Drug Use Review in a Skilled Nursing Facility

Brodie, Donald C.; Lofholm, Paul W.; Benson, Roger A.

doi:10.1016/s0003-0465(16)34479-2

Cited by 5 publications

(4 citation statements)

References 4 publications

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“…Further, it is not clear how the reduction in orders for PRN drugs related to changes in medications actually administered, particularly if many “standing” orders were infrequently implemented before the intervention. In two very similar studies, Cheung and Kayne 68 and Brodie et al 69 reported reductions in prescriptions of 18% (6.8 to 5.6) and 32% (6.8 to 4.6), respectively, associated with the institution of drug‐utilization review services.…”

Section: Factors Contributing To Inappropriate Prescribingmentioning

confidence: 93%

Improving Medication Prescribing and Utilization in the Nursing Home

Gurwitz

Soumerai

Avorn

1990

J American Geriatrics Society

140

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There is ample and compelling evidence to suggest that medications are frequently used inappropriately in the nursing home. The occurrence of avoidable adverse drug reactions is the most serious consequence of inappropriate prescribing; economic implications are also of interest. With increasing concern over the quality of care in nursing homes, and with the revision of regulations governing such care by the Health Care Financing Administration, it is important to consider the experience thus far in monitoring and improving drug use in nursing homes. A number of studies have investigated approaches designed to reduce inappropriate prescribing and drug utilization in this setting. In contrast to the wide range of approaches that have been evaluated and implemented in the hospital setting, interventions in the nursing home have centered primarily around consultant-pharmacist activities. Although these activities are now federally mandated in all nursing homes, there is little evidence from adequately controlled studies to document their impact or cost-effectiveness. By contrast, face-to-face educational interventions directed at physicians ("academic detailing") have been shown to be effective in improving prescribing for some medications. The prominent role played by the nursing staff in the utilization of many medications in the nursing home implies that an educational intervention excluding nursing staff would be insufficient to influence drug utilization positively in many situations (eg, psychoactive medications and laxatives). Future research efforts must pay greater attention to adequate study design considerations as well as to the clinical outcomes of such interventions and their cost-effectiveness.

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Section: Factors Contributing To Inappropriate Prescribingmentioning

confidence: 93%

Improving Medication Prescribing and Utilization in the Nursing Home

Gurwitz

Soumerai

Avorn

1990

J American Geriatrics Society

140

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“…Care of the elderly living in long‐term institutions has attracted much attention in the United States. Numerous studies on prescribing for this tiny sector of the community (less than 5% of all persons aged 65 years or older) have been published 36–49 …”

Section: Prescribing For the Elderly In Long‐term‐care Institutionsmentioning

confidence: 99%

“…The introduction of clinical pharmacists to monitor drug use in American nursing homes has been associated with a decrease in the number of prescribed drugs taken per patient from seven to five. Many studies have shown that substantial reductions (12% to 39%) in the number of medicines prescribed are possible with no apparent untoward consequences to the patient 43–49 …”

Section: Prescribing For the Elderly In Long‐term‐care Institutionsmentioning

confidence: 99%

Prescribing for the Elderly: Part II Prescribing Patterns: Differences Due to Age

Nolan

O’Malley

1988

J American Geriatrics Society

115

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“…Other observers (2–7) have noted the misuse of drugs in LTCFs and have documented the influence of the consultant clinical pharmacist in the reduction of medication errors and the number of drugs per patient, as well as improvement in the means of communication. Still others (8–9) have recently expressed concern about their findings in LTCFs in which an aggressive review of drug use is not being practiced.…”

Section: Discussionmentioning

confidence: 99%

Contribution of the Consultant Pharmacist to Rational Drug Usage in the Long‐Term Care Facility*

Cooper

Bagwell

1978

J American Geriatrics Society

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In a rural 116-bed skilled nursing facility, a study was made of the influence of a Consultant Pharmacist on drug usage over a one-year period. Lines of communication were established with the six attending physicians by means of work rounds, telephone calls, and both official and unofficial memoranda. Daily pharmacy rounds were conducted with health-care students and the nursing supervisor, who facilitated physician-pharmacist communication. The physician-nurse-pharmacist team studied each patient's problems, the status of the therapeutic endpoint, and the need of and usage of each regularly scheduled or pro re nata (PRN) drug. Stop-order and standing-order protocols were developed. During the one-year period, the number of regularly scheduled drugs per patient was reduced from 3.30 to 2.66 (19.4 percent decrease), and of PRN drugs from 3.92 to 2.12 (45.9 percent decrease). The overall significant reduction was associated with the protocol and stop-order discontinuances of routinely scheduled drugs, and with the duplicated orders for drugs to relieve pain, nausea, vomiting, diarrhea, colds and cough. Implications for optimal care of the patients, and for the economics of this federally-mandated system of consultant pharmacists are discussed.

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A Model for Drug Use Review in a Skilled Nursing Facility

Cited by 5 publications

References 4 publications

Improving Medication Prescribing and Utilization in the Nursing Home

Improving Medication Prescribing and Utilization in the Nursing Home

Prescribing for the Elderly: Part II Prescribing Patterns: Differences Due to Age

Contribution of the Consultant Pharmacist to Rational Drug Usage in the Long‐Term Care Facility*

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