Residential Aged Care Medication Review to Improve the Quality of Medication Use: A Systematic Review

Thiruchelvam, Kaeshaelya; Hasan, Syed Shahzad; Wong, Pei Se; Kairuz, Therése

doi:10.1016/j.jamda.2016.10.004

Cited by 47 publications

(73 citation statements)

References 51 publications

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“…staff of the nursing home, general practitioner or pharmacist) . A recent systematic review concluded that medication reviews conducted by pharmacists or a multidisciplinary team appear to reduce the number of prescribed medications, the number of potentially inappropriate medications and adverse effects, including hospitalisations and mortality . We have demonstrated that the use of potentially inappropriate medications was associated with quality of life in older adults living in nursing homes with a high prevalence of cognitive impairment and dementia .…”

Section: Discussionmentioning

confidence: 99%

Patterns of medication prescription by dementia diagnosis in Australian nursing home residents: a cross‐sectional study

Liu

Dyer

Whitehead

et al. 2019

Pharmacy Practice and Res

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Background Current information on the patterns of medication use in nursing home residents living with dementia is conflicting. Aim The aim of this study was to investigate medication use and its associations with dementia diagnosis in Australian nursing home residents. Methods A cross‐sectional study of 541 residents from 17 Australian nursing homes was performed. Results Over 12 months, nursing home residents were prescribed a mean (±SD) of 14.5 ± 6.8 medications each. Approximately 95% of residents were prescribed medications for the nervous system, and 94% were prescribed medications for the alimentary tract and metabolism. After adjustment for potential confounders, those with dementia were less likely to be prescribed medications for the cardiovascular system (odds ratio (OR) 0.45, 95% confidence interval (CI) 0.27–0.77, p = 0.0032) and respiratory system (OR 0.38, 95% CI: 0.25–0.60, p < 0.0001). Further analysis of specific medications showed that residents with dementia were more likely to be prescribed risperidone (OR: 9.38, 95% CI: 4.01–21.94, p < 0.0001), buprenorphine (OR 3.37, 95% CI: 1.78–6.36, p = 0.0002) and trimethoprim (OR 1.78, 95% CI: 1.06–2.97, p = 0.0282), but less likely to be prescribed glyceryl trinitrate (OR 0.42, 95% CI: 0.19–0.94, p = 0.0340) and salbutamol (OR 0.34, 95% CI: 0.2–0.6, p = 0.0002) in addition to other specific medications. Conclusions Increased awareness of possible undertreatment of cardiovascular and respiratory conditions, and possible overtreatment of urinary tract infection, in those living with dementia in nursing home settings may improve management of this vulnerable population.

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Section: Discussionmentioning

confidence: 99%

Patterns of medication prescription by dementia diagnosis in Australian nursing home residents: a cross‐sectional study

Liu

Dyer

Whitehead

et al. 2019

Pharmacy Practice and Res

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“…Although there are strategies in place to improve the welfare and QoL of residents in RACFs in Malaysia, these services may be underutilised. It would be feasible to ensure community and hospital pharmacists conduct medication reviews on a part‐time basis in RACFs, because this has been shown to improve the quality of medication use . Because an HMR service has been established by the Ministry of Health, this strategy could be expanded to incorporate reviews for residents in RACFs by implementing a schedule‐based approach for government pharmacists to visit RACFs on a weekly basis to provide medication review services.…”

Section: Discussionmentioning

confidence: 99%

Drug burden index, polypharmacy and patient health outcomes in cognitively intact older residents of aged care facilities in Malaysia

Hasan

Chang

Thiruchelvam

et al. 2020

Pharmacy Practice and Res

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Background The complexity of drug regimens among older people tend to increase over time, as multiple medications are required to treat a single condition. Aim This study examined the association of the drug burden index (DBI) and polypharmacy with patient health outcomes among cognitively intact older residents in aged care facilities (ACFs). Methods A review of prescribed medications and related outcomes was conducted in a cross‐sectional sample of older adults (≥60 years), recruited from 11 ACFs in Peninsular Malaysia. Frailty and quality of life (QoL) were evaluated using the Groningen frailty indicator and ‘Older People's Quality of Life – 35’ questionnaire, respectively; patients’ exposure to anticholinergic and sedative medicines was quantified using the DBI; and the mental health of residents was evaluated using the Hospital Anxiety and Depression Scale. Results More than two‐thirds of a sampled population received at least one anticholinergic or sedative medication and more than one‐quarter was exposed to polypharmacy. Exposure to DBI‐associated medications was noted in three of every four frail participants and was significantly correlated with frailty (r = 0.184, p = 0.023). The frail population had significantly increased risk of polypharmacy (odds ratio 6.07; 95% confidence interval 1.71–21.56; p = 0.005), but exposure to DBI‐associated medications was not significantly associated with overall QoL and activity of daily living measures. Conclusion Polypharmacy and anticholinergic and sedative burden were noticed in a substantial number of older adults in residential aged care facilities and were associated with frailty. Investing in the recruitment of pharmacists may benefit recognition of residential ACF quality of care, because pharmacy services (including pharmacists) are virtually non‐existent in Malaysian residential ACFs.

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“…Lack of on‐site pharmacy services has been cited as a risk factor for medication errors in RACHs . There is evidence suggesting pharmacist involvement in resident care may improve aspects of quality use of medicines, including identification and resolution of drug‐related problems . Pharmacists may also optimize safe medication administration in residents with dysphagia .…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…1 Rates of chronic diseases are also rising, as is the intensification of pharmacological disease management and multiple medicines usage. [2][3][4] RACH residents are higher users of medications compared to older people residing in family homes, using an average of almost 10 medications per resident. 1,5 Medication administration is a fundamental and important nursing and carer task in resident care and safety.…”

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

The effect of a residential care pharmacist on medication administration practices in aged care: A controlled trial

et al. 2019

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What is known and objective With the ageing of the population also comes increasing comorbidities and the use of multiple medications and administration methods, along with greater susceptibility to adverse drug reactions. Dosage form modification to facilitate drug administration in older adults can be potentially problematic as altering the original licensed formulation can affect medication safety and efficacy. The reporting of adverse drug reactions and medication incidents is a key strategy in avoiding preventable adverse drug events for aged care residents. This study evaluated the effect of an on‐site clinical pharmacist on reducing inappropriate dosage form modification and staff time spent on medication administration, and optimizing the documentation of drug allergies, adverse drug reactions and medication incidents. Methods A pilot‐controlled trial was performed in a purposive sample of two residential aged care homes. Both homes belonged to the same organization; the study site had 104 beds and the control site had 100 beds. All permanent residents were eligible for inclusion in the study if written consent was provided. A residential care pharmacist position was implemented at the study site for six months, with a focus on performing medication reviews and quality improvement activities. Observational audits of medication rounds were performed, and documentation relating to allergies, adverse drug reactions, and medication incidents was obtained from both sites before and after the pharmacist trial period. Results At the study site, there was a significant reduction over the trial in the proportion of inappropriate dosage form modification (from 24% to 0% of all dosage form modifications; P < 0.01). Mean time spent on medication rounds per resident reduced from 4.8 minutes per resident (SD 1.1) to 3.2 minutes per resident (SD 1.7) per round (P < 0.05). The incidence of previous allergy and adverse drug reaction documentation significantly improved from 77% of residents pre‐study to 100% of residents post‐study (P < 0.01). Mean monthly medication incident reports significantly improved from 13.3 (SD 7.4) pre‐study to 25.7 (SD 10.8) post‐study (P < 0.05). There was no change in these outcomes at the control site. What is new and conclusion Including a pharmacist in a residential aged care home can improve medication administration practices by reducing inappropriate dosage form modification and staff time spent on medication administration rounds, and increasing the documentation of resident allergies, adverse drug reactions and medication incidents. These findings warrant further exploration in a large randomized controlled trial.

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Residential Aged Care Medication Review to Improve the Quality of Medication Use: A Systematic Review

Cited by 47 publications

References 51 publications

Patterns of medication prescription by dementia diagnosis in Australian nursing home residents: a cross‐sectional study

Patterns of medication prescription by dementia diagnosis in Australian nursing home residents: a cross‐sectional study

Drug burden index, polypharmacy and patient health outcomes in cognitively intact older residents of aged care facilities in Malaysia

The effect of a residential care pharmacist on medication administration practices in aged care: A controlled trial

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