Inappropriate prescribing to nursing home residents

Dr Stephen Byrne

Dr Stephen Byrne

Share this

Research into nursing homes in Munster has found that a significant proportion of patients have either been prescribed a potentially inappropriate medicine or not given a beneficial one.

 

The research by Dr Stephen Byrne, UCC School of Pharmacy and co- authors identified 329 instances of potentially inappropriate prescribing (PIP) in 187 (59.8%) patients. Of these patients, 98 (31.3%) were prescribed one medicine that was potentially inappropriate, 47 (15.0%) were prescribed two, and 32 (10.2%) were prescribed three. Medicine for the central nervous system accounted for the highest proportion of PIP identified, followed by high proportions of medication for the gastrointestinal system, the cardiovascular system, and for patients who frequently fall. In this group, benzodiazepines accounted for the highest proportion of potentially inappropriate medicines prescribed. The research was published today in  the journal Age and Ageing published by Oxford University Press.

The study also identified 199 potential prescribing omissions in 132 patients. The cardiovascular system accounted for most of the potential prescribing omissions identified and of these, the most common was the omission of a low-dose aspirin.

Dr Stephen Byrne, from University College Cork, comments that “the figures found in this study are higher when compared with figures reported in studies conducted in primary and in secondary care.  This may reflect the higher levels of multiple chronic conditions found in older patients residing in long term care facilities, which often results in more medicines being prescribed.”

“We found that medicines for the blood and blood forming organs accounted for almost ten per cent (9.2%) of the medicines prescribed in this study. We feel that this is an underestimation of the true requirements for these medicines, as anti-platelet agents and anticoagulants accounted for a third of the omissions identified.”

“Our study shows that there is a need to consider measures of ensuring patients are not at risk of medication related adverse events. The screening tools STOPP and START could form the basis of a pharmaceutical care review for these patients. The feasibility of establishing such a service needs to be further explored.”

The study, entitled ‘Potentially inappropriate prescribing in older residents in Irish nursing homes’, collected data from seven publicly funded nursing homes in Muster over a period of three weeks.  In total, 313 patients were recruited for the study and over the three week period in 2008, the author’s collected data about current medication and medical conditions, allergy status, biochemistry result and also other relevant previous conditions. The authors used the STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) screening tool and looked for instances of PIP and PPO in these prescriptions.

« Previous Item

Next Item »




« Back to 2012 Press Releases