Medication reviews in nursing homes: Documenting and classifying the activities of a pharmacist

AIM · To devise a system of documentation for use by pharmacists engaged in nursing home medication reviews and to report die activities of one such pharmacist. DESIGN · Four-month intervention trial. SETTING · 14 nursing homes in south Manchester. OUTCOME MEASURES · Types of recommendations made by the pharmacist. GP acceptance and implementation of pharmacist recommendations. Subjective indication of the impact of the medication review on residents. RESULTS · A "Pharmline" literature review revealed no documentation system designed specifically for review of medication regimes in nursing homes. Consequently, a document was developed and used as part of an intervention trial. 136 residents had their medication reviewed by the pharmacist which resulted in 261 recommendations. Of these, 239 (91.6%) were accepted by the GP and there were 144 (55.2%) treatment modifications. Nursing home staff reported few subjective problems arising from these treatment changes. The most frequent recommendation was to stop medication (47%) with laboratory test requests also being common. (15%). The most common reason for a recommendation was to discontinue a medication because there was no longer an indication for its use (33%). Economy was the sole reason to modify therapy in only 7% of cases. CONCLUSIONS · A documentation system was developed for collecting relevant clinical data together with the types and number of recommendations made by a pharmacist in nursing homes. Pharmacists are able to make an active contribution to medication review in nursing homes and their advice is well accepted by GPs.