Care home patients exposed to drug errors

ALMOST SIX out of 10 nursing home residents in Munster are exposed to potentially inappropriate prescribing, new research has found.

Doctors from Cork University Hospital collected data on 313 patients from seven publicly funded nursing homes in the Munster region over a three-week period in 2008. They identified some 329 instances of potentially inappropriate prescribing (PIP) in 187 (59.7 per cent) patients. Of these patients, 31 per cent were prescribed one medicine that was potentially inappropriate, 15 per cent were prescribed two, while 10 per cent were prescribed three potentially unsuitable drugs.

PIP includes cases in which patients have been prescribed a potentially harmful medication, as well as instances in which they are prescribed a medicine that, in the researchers’ opinion, would normally be beneficial.

The authors of the study, published this morning in the journal Age and Ageing, collected data about patients’ current medication and medical conditions, allergy status, laboratory results and other relevant previous conditions. The authors used the Stopp (Screening Tool of Older Persons’ Prescriptions) and Start (Screening Tool to Alert doctors to Right Treatment) utilities as part of their assessment.

Medicines for the central nervous system accounted for the highest proportion of PIP identified, followed by high proportions of medication for the gastrointestinal system and the cardiovascular system. Among patients who frequently fall, benzodiazepines accounted for the highest percentage of PIP.

The PIP rates reported by the study are higher than those reported in primary care settings (21 per cent) and in hospitals (35 per cent). The researchers also identified 199 potential prescribing omissions (PPO) in 132 patients. The cardiovascular system accounted for most of the PPOs.

One of the authors, Stephen Byrne, from the pharmacy department at University College Cork, said: “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 result in more medicines being prescribed.”

In European nursing home settings, PIP rates of up to 48 per cent have been reported.

The Health Information and Quality Authority recently introduced medication review standards for patients in nursing homes.

“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,” Dr Byrne concluded.