A study of the appropriateness of prescribing in nursing homes

Abstract

A study carried out in five nursing homes and 13 general practitioner practices in the North West National Health Service region investigated medicine use in the homes and assessed the extent of inappropriate prescribing using consensus derived criteria. A review of the medical and nursing records of 101 residents showed that they were using a total of 714 items (mean 7.1; range 0 to 15), of which 659 were medicines, including 51 dressings, and 55 were other items such as stoma products. When criteria for inappropriate prescribing were developed and applied, 54 (53 per cent) residents were judged to have one or more inappropriate prescriptions. Medicines most frequently associated with inappropriate prescribing were those for the cardiovascular system (57 per cent of inappropriate prescriptions) and the central nervous system (17 per cent); diuretics accounted for 41 per cent of all inappropriate prescriptions. However, these results may not be representative of the true level of inappropriate prescribing. Of the eight GPs who filled in a questionnaire, five had a system for regularly reviewing drug treatment for nursing home residents; all considered that nursing home residents could benefit if pharmacists were to support GPs by offering advice about individual residents' drug treatment. Elderly residents in nursing homes are at high risk of inappropriate prescribing. A role for pharmacists in the monitoring of individual residents' prescriptions, in academic detailing or in guideline development could help in improving the quality of prescribing for nursing home residents.