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

Abstract

As the population continues to age, long-term care for older people will be required, although the setting and method of delivery may differ depending on people's needs. We anticipate that nursing homes will continue to be part of the overall long-term care delivery model, but will face a number of challenges if they are to be considered as much sought-after places. This paper highlights three issues in relation to prescribing that have been largely ignored to date, but which need to be considered by practitioners, policy makers and researchers alike: culture; resident-centred decision-making and care at the end of life. There has been growing interest in culture within organisations and how this may influence behaviour and performance. In this paper, we will consider how culture may influence prescribing. Culture is important in how it contributes to resident-centred care and this leads to a consideration on how residents may be involved in decision-making, specifically in the area of medicines. Finally, care at the end of life in nursing homes, particularly in those with dementia, has been shown to be poor in quality, and this also encompasses the medicines that are prescribed. Palliative services need to be developed to meet the requirements of some of the most vulnerable residents in this care setting.

Antibiotic prescribing in long-term care facilities: a qualitative, multidisciplinary investigation

“…It has been well acknowledged that LTCFs have a wide variety of organisational models and service delivery structures, for example, nurse to resident ratio, access to doctor, access to diagnostic equipment or microbiology results 32. The influential role of nurses, the variability in practices between LTCFs, and the ethical considerations of caring for patients with dementia and at the end of their life are all characteristic features of LTCF services that must be considered when planning quality improvement strategies 8. The Schein model of organisational culture, as previously discussed by Hughes et al 33, suggests that in order to truly understand an organization, a deeper knowledge of the underlying assumptions needs to be analysed, and not just the observable patterns of behaviour.…”

“…Recent systematic reviews of qualitative studies of antibiotic prescribing behaviour have focused mainly on the overall primary care or secondary care setting without focusing on the LTCFs setting specifically 67 It is necessary to evaluate LTCFs as a separate setting for antibiotic prescribing because patient care is often influenced by factors unique to this setting, such as the comorbidities of the patient population and organisational culture 8…”

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

“…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.…”