Prescribing for older people in nursing homes: strategies to improve prescribing and medicines use in nursing homes

Abstract

Interventions to improve prescribing in the nursing home environment are many and varied. The critical literature review presented in Paper 1 (Parsons et al., 2011, International Journal of Older People Nursing 6, 45-54) in this series discussed the main issues repeatedly identified as problematic, and this paper summarises the main approaches which have been used to attempt to improve prescribing. These include national legislation which demands documented justification for the prescribing of medicines, medication review, approaches to reducing medication errors, improving communication across care boundaries and assessment teams and alternative service models. It is difficult to make global recommendations as some of these approaches are country specific or have been delivered in different ways, involving different professionals. However, a series of prompt questions have been provided which may assist nursing home staff in deciding whether prescribing is optimal in a resident or if an intervention is required which may lead to an overall improvement in outcomes.

Prescribing for older people in nursing homes: a review of the key issues

“…Despite concerns surrounding inappropriate polypharmacy, there is increasing interest in appropriate polypharmacy, particularly in older people with multiple co‐morbidities. Appropriate polypharmacy has been identified as an approach to improve the quality of drug therapy in the nursing home setting (Gurwitz, 2004), and will be discussed in the next paper in this series (Parsons et al , 2011).…”

“…In this article, the first in a series of three articles examining pharmaceutical issues in nursing homes, we seek to consider the key issues surrounding prescribing and use of medicines in the nursing home setting. Ways of influencing medication use in nursing homes will be discussed in detail in the second paper in this series (Parsons et al , 2011), while paper 3 (Hughes et al , 2011) will speculate as to what could be the key considerations in respect of medicines for nursing homes in the future.…”

Prescribing for older people in nursing homes: challenges for the future

“…The strategies outlined in Paper 2 (Parsons et al , 2011a) are approaches that have been shown to improve prescribing and medication use, but apart from the policy approach taken with Omnibus Budgetary Reconciliation Act (OBRA) there have been few national or comprehensive strategies to oversee prescribing in nursing homes. Indeed, the literature also suggests that even with a national policy such as OBRA, there is marked variation in prescribing patterns across nursing homes.…”

“…The two previous papers in this series (Parsons et al , 2011a,b) have highlighted important issues about medications in nursing homes and proposed strategies to improve the processes and outcomes associated with prescribing medications. Of course, we are working under the assumption that nursing homes as we currently understand them will continue to be providers of long‐term for older people.…”

“…Prescribing is one of the most common medical intervention experienced by older residents in nursing homes (Lapane & Hughes, 2002), and is likely to be an ongoing consideration for this population, irrespective of how long‐term care is organised and delivered. A number of the approaches described in Paper 2 (Parsons et al , 2011a) have been shown to be successful, albeit in some cases, under research conditions, but have not been followed with wide‐scale implementation. A national legislative approach as exemplified in the USA has resulted in improvements in several indices of care, but using legislation in this way has not been replicated in other countries and there are still concerns about the quality of care in US nursing homes (Hughes & Lapane, 2005).…”