The Role of the Pharmacist in a Geriatric Nursing Home: A Literature Review

Abstract

This review delineates the pharmacist's controversial clinical role in nursing homes as it has developed within the legal, social, and economic climate of the Medicaid and Medicare conditions of participation. Special problems of the geriatric institutionalized patient include polypharmacy, adverse reactions, the overuse of prn drugs, and inadequate physician contact. These problems are compounded by an impoverished scientific data-base for appropriate drug use in the aged. Studies that clarify the impact consultant pharmacists have on the number of drugs prescribed, adverse reactions, and cost containment are compiled and evaluated. It is shown that pharmacists can reduce the number and cost of drugs. Physician acceptance of pharmacists' recommendations was found to be at least 60 percent in these reports. Well-controlled studies are lacking in the literature.

Medication use in nursing homes for elderly people

“…They advise medical practitioners on matters such as choice and duration of drug therapy and also participate in sta education about medication. Physician acceptance of pharmacist recommendations is high and has been reported as being between 60% and 81% (Dyer et al, 1984;Miller et al, 1993). Thompson et al (1984) described a situation where clinical pharmacists assumed total responsibility for the drug management of a group of geriatric patients in a nursing home, comparing this group with a control group who received traditional patient care.…”

Perspectives on geriatrics by pioneers in aging: Reflections of a clinical pharmacist

“…There, Greg Warshaw, MD, a geriatrician trained in Wales and the United States, taught me the importance of geriatric pharmacotherapy as part of interdisciplinary team care provided in home, hospital, and nursing home care settings 7 . I also began serving as a nursing home consultant pharmacist after visiting with and the continued support of two early and outstanding North Carolina geriatric clinical pharmacists in nursing home care services: Karen Oles, PharmD and Don Holloway, PharmD 8,9 . In addition, I also studied the writings of three of the early pioneers in geriatric pharmacy practice and research: Peter Lamy, PhD from the University of Maryland, James Cooper, PhD from the University of Georgia, and Ronald Stewart MS Pharm from the University of Florida 10‐12 .…”

Medical errors and their prevention

“…One of the most common, clinically important and costly problems is Medication errors and adverse drug events (ADEs)-injuries that result from the use of a drug [2]. Both adult and pediatric studies have found that about half of all medication errors occur during the drug ordering, although another technique-direct observation, has shown that errors also occur during the administration stage.…”