Variations in drug-related problems detected by multidisciplinary teams in Norwegian nursing homes and home nursing care

Devik, Siri Andreassen; Olsen, Rose Mari; Fiskvik, Inger Lise; Halbostad, Terje; Lassen, Tone; Kuzina, N.; Enmarker, Ingela

doi:10.1080/02813432.2018.1499581

Cited by 34 publications

(33 citation statements)

References 32 publications

(49 reference statements)

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“…In a recent study using the same classification tool as we did, Devik et al found a mean of 3.7 MRPs per nursing home resident. They found that most of the MRPs related to unnecessary medication use (28%) or to need for additional medications (22%), while we identified most problems in relation to unnecessary medication use, to high doses and drug interactions [9].…”

Section: Medication Use and Medication Related Problemsmentioning

confidence: 68%

“…The interdisciplinary team agreed upon 62% of the MRPs identified by the pharmacist, which is lower, but within range of the acceptance rate of 71% reported by Devik et al [9]. The purpose of the MRP classification tool was to investigate areas of sub-optimal quality in relation to the residents' entire medication regimen.…”

Section: The Interdisciplinary Team Collaborationmentioning

confidence: 76%

“…In Norway, it is still rather uncommon that pharmacists are engaged as regular primary care interdisciplinary team members. This might be due to the fact that many of the pharmacist-led medication review studies conducted in nursing homes have been purely descriptive cross-sectional, or before and after studies [9,10]. Consequently, they have failed to provide strong evidence about how identifying, solving and preventing MRPs may affect endpoints like quality of life, hospitalization, and death.…”

Section: The Interdisciplinary Team Collaborationmentioning

confidence: 99%

“…The provision of rational medication therapy in frail elderly is a difficult task and requires extensive knowledge about medications [7,8]. Medication reviews in interdisciplinary teams have shown promising results to reduce MRPs in frail nursing home residents [9,10].…”

Section: Introductionmentioning

confidence: 99%

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A Stepwise Pharmacist-Led Medication Review Service in Interdisciplinary Teams in Rural Nursing Homes

2019

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Background: The provision of responsible medication therapy to old nursing home residents with comorbidities is a difficult task and requires extensive knowledge about optimal pharmacotherapy for different conditions. We describe a stepwise pharmacist-led medication review service in combination with an interdisciplinary team collaboration in order to identify, resolve, and prevent medication related problems (MRPs). Methods: The service included residents from four rural Norwegian nursing homes during August 2016–January 2017. All residents were eligible if they (or next of kin) supplied oral consent. The interdisciplinary medication review service comprised four steps: (1) patient and medication history taking; (2) systematic medication review; (3) interdisciplinary case conference; and (4) follow-up of pharmaceutical care plan. The pharmacist collected information about previous and present medication use, and clinical and laboratory values necessary for the medication review. The nurses collected information about possible symptoms related to adverse drug reactions. The pharmacist conducted the medication reviews, identified medication-related problems (MRPs) which were discussed at case conferences with the responsible physician and the responsible nurses. The main outcome measures were number and types of MRPs, percentage agreement between pharmacists and physicians and factors associated with MRPs. Results: The service was delivered for 151 (94%) nursing home residents. The pharmacist identified 675 MRPs in 146 (97%) medication lists (mean 4.0, SD 2.6, range 0–13). The MRPs most frequently identified concerned ‘unnecessary drug’ (22%), ‘too high dosage’ (17%) and ‘drug interactions’ (16%). The physicians agreed upon 64% of the pharmacist recommendations, and action was taken immediately for 32% of these. We identified no association between the number of MRPs and sex (p = 0.485), but between the number of MRPs, and the number of medications and the individual nursing homes. Conclusion: The pharmacist-led medication review service in the nursing homes was highly successfully piloted with many solved and prevented MRPs in interdisciplinary collaboration between the pharmacist, physicians, and nurses. Implementation of this service as a standard in all four nursing homes seems necessary and feasible. If such a service is implemented, effects related to patient outcomes, interdisciplinary collaboration, and health economy should be studied.

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Section: Medication Use and Medication Related Problemsmentioning

confidence: 68%

Section: The Interdisciplinary Team Collaborationmentioning

confidence: 76%

Section: The Interdisciplinary Team Collaborationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Stepwise Pharmacist-Led Medication Review Service in Interdisciplinary Teams in Rural Nursing Homes

2019

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“…Compliance-related problems describe instances when a client prefers not to take a medication, does not understand how to use a medication, or cannot afford a medication. A client is experiencing a compliancerelated problem if he or she does not understand how to use an inhaler or prefers not to take a medication to treat a condition [1], [4], [5].…”

Section: Common Mrps and Success Of Pharmacy Visits At Homementioning

confidence: 99%