Nurse-led intervention to minimise adverse drug reactions for older adults in care homes

 Adverse drug reactions (ADRs) are responsible for 5–8% of unplanned hospital admissions in the UK, and 18% of primary care patient safety incidents are attributed to prescription medicines, particularly avoidable ADRs. Most ADRs are due to poor monitoring, not poor prescribing.

ADRs are a particular issue in care homes, where up to 50% of people are over-prescribed medicines. Polypharmacy, the use of multiple medicines, is a major patient safety issue for older people, who are exposed to medicines that are responsible for high rates of hospitalisation.

This project run by Aneurin Bevan University Health Board will involve analysing polypharmacy-related incidents involving older people that have been reported to a national database – the National Reporting and Learning System.

These reports will then be analysed by a trained team consisting of a pharmacist, a doctor and a nurse to establish how they might have been prevented.

The findings will form the basis of a new nurse-led intervention to monitor and manage medicines, and avoid ADRs in people in care homes.

The intervention, based on a similar intervention for mental health medicines, will allow nurses to identify problems that could be addressed by changes in care and discussion with prescribers. It will facilitate shared decision-making by providing information on previously unrecognised or unmonitored problems: problems that might be alleviated if medicine doses, formulations or timings were changed.

The medicines monitoring intervention will be introduced into seven care homes with around 190 residents who are prescribed more than four medicines.

Contacts

For more information about this project, please contact Andrew Carson-Stevens, Project Clinical Lead and GP Registrar, Aneurin Bevan University Health Board or Sue Jordan, Swansea University (for details of the nurse-led monitoring intervention).