Skip to main content

Advertisement

SpringerLink
Log in

Nurse-led medication reviews and the quality of drug treatment of elderly hospitalized patients

  • Clinical Trial
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate if nurses after receiving training in clinical pharmacology can improve the quality of the drug therapy in elderly hospitalized patients.

Methods

Nurses were given a 1-day training in clinical pharmacology to identify drug-related problems (DRPs). All patients admitted to the ward aged 65 or more were studied. Patients at the same ward before the intervention were considered as control group. Outcome variables were re-hospitalized 3 months from discharge, drug-related re-admissions, the proportion of inappropriate drug use (IDU), and DRPs found by the nurses.

Results

Of 460 patients (250 intervention group and 210 in the control group) 38 and 36%, respectively, had at least one re-admission to hospital (p = 0.86) and 24% of the patients died. Eighteen and 17% (43/37), respectively, used one or more inappropriate drug (p 0.90). The nurses found 86 clinically significant DRPs not detected by the usual care. A substantial part of the DRPs detected by the nurses were revealed with assistance of Symptoms Assessment Form (SYM). There were no statistical difference in the number of drug-related re-admissions between the groups, 14/16, respectively, (p = 0.40).

Conclusions

Nurses are able to detect a high proportion of clinically relevant DRPs not detected by the usual care and thereby increase the quality of the drug treatment in elderly hospitalized patients. Our study showed no effect on re-hospitalization or IDU. By using a SYM nurses can find DRPs that computer-based decision support systems miss.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Routledge PA, O’Mahony MS, Woodhouse KW (2004) Adverse drug reactions in elderly patients. Br J Clin Pharmacol 57(2):121–126

    Article  CAS  PubMed  Google Scholar 

  2. Kongkaew C, Noyce PR, Ashcroft DM (2008) Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother 42(7):1017–1025

    Article  PubMed  Google Scholar 

  3. Passarelli MC, Jacob-Filho W, Figueras A (2005) Adverse drug reactions in an elderly hospitalised population: inappropriate prescription is a leading cause. Drugs Aging 22(9):767–777

    Article  PubMed  Google Scholar 

  4. Hanlon JT et al (2006) Incidence and predictors of all and preventable adverse drug reactions in frail elderly persons after hospital stay. J Gerontol A Biol Sci Med Sci 61(5):511–515

    PubMed  Google Scholar 

  5. Zopf Y et al (2008) Risk factors associated with adverse drug reactions following hospital admission: a prospective analysis of 907 patients in two German university hospitals. Drug Saf 31(9):789–798

    Article  PubMed  Google Scholar 

  6. Rang HP, Dale MM, Ritter JM, Moore PK (2007) Rang & Dales pharmacology. 6th ed. Churchill Livingstone, Edinburgh

  7. Pena Porta JM, de Vera Floristan CV, Bueno Lozano M (2007) Hidden renal failure and drug prescription in hospitalized patients. An Med Interna 24(5):221–226

    CAS  PubMed  Google Scholar 

  8. Klarin I, Wimo A, Fastbom J (2005) The association of inappropriate drug use with hospitalisation and mortality: a population-based study of the very old. Drugs Aging 22(1):69–82

    Article  PubMed  Google Scholar 

  9. Blix HS et al (2006) Use of renal risk drugs in hospitalized patients with impaired renal function-an underestimated problem? Nephrol Dial Transplant 21(11):3164–3171

    Article  PubMed  Google Scholar 

  10. Fick DM et al (2008) Health outcomes associated with potentially inappropriate medication use in older adults. Res Nurs Health 31(1):42–51

    Article  PubMed  Google Scholar 

  11. Gallagher P, Barry P, O’Mahony D (2007) Inappropriate prescribing in the elderly. J Clin Pharm Ther 32(2):113–121

    Article  CAS  PubMed  Google Scholar 

  12. Johnell K et al (2007) Inappropriate drug use in the elderly: a nationwide register-based study. Ann Pharmacother 41(7):1243–1248

    Article  PubMed  Google Scholar 

  13. Bergman A et al (2007) Evaluation of the quality of drug therapy among elderly patients in nursing homes. Scand J Prim Health Care 25(1):9–14

    Article  PubMed  Google Scholar 

  14. Beers MH (1997) Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 157(14):1531–1536

    Article  CAS  PubMed  Google Scholar 

  15. O’Mahony D, Gallagher PF (2008) Inappropriate prescribing in the older population: need for new criteria. Age Ageing 37(2):138–141

    Article  PubMed  Google Scholar 

  16. Beijer HJ, de Blaey CJ (2002) Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci 24(2):46–54

    Article  CAS  PubMed  Google Scholar 

  17. Mjorndal T et al (2002) Adverse drug reactions as a cause for admissions to a department of internal medicine. Pharmacoepidemiol Drug Saf 11(1):65–72

    Article  PubMed  Google Scholar 

  18. Royal S et al (2006) Interventions in primary care to reduce medication related adverse events and hospital admissions: systematic review and meta-analysis. Qual Saf Health Care 15(1):23–31

    Article  CAS  PubMed  Google Scholar 

  19. Yee JL, Hasson NK, Schreiber DH (2005) Drug-related emergency department visits in an elderly veteran population. Ann Pharmacother 39(12):1990–1995

    Article  PubMed  Google Scholar 

  20. Dormann H et al (2004) Readmissions and adverse drug reactions in internal medicine: the economic impact. J Intern Med 255(6):653–663

    Article  CAS  PubMed  Google Scholar 

  21. Pirmohamed M et al (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 329(7456):15–19

    Article  PubMed  Google Scholar 

  22. Franceschi M et al (2008) Prevalence, clinical features and avoidability of adverse drug reactions as cause of admission to a geriatric unit: a prospective study of 1756 patients. Drug Saf 31(6):545–556

    Article  PubMed  Google Scholar 

  23. Allard J et al (2001) Efficacy of a clinical medication review on the number of potentially inappropriate prescriptions prescribed for community-dwelling elderly people. CMAJ 164(9):1291–1296

    CAS  PubMed  Google Scholar 

  24. Holland R et al (2008) Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis. Br J Clin Pharmacol 65(3):303–316

    Article  PubMed  Google Scholar 

  25. Mannheimer B et al (2008) A clinical evaluation of the Janus Web Application, a software screening tool for drug-drug interactions. Eur J Clin Pharmacol 64(12):1209–1214

    Article  CAS  PubMed  Google Scholar 

  26. Mannheimer B et al (2006) Drug-related problems and pharmacotherapeutic advisory intervention at a medicine clinic. Eur J Clin Pharmacol 62(12):1075–1081

    Article  PubMed  Google Scholar 

  27. Blue L et al (2001) Randomised controlled trial of specialist nurse intervention in heart failure. BMJ 323(7315):715–718

    Article  CAS  PubMed  Google Scholar 

  28. de la Porte PW et al (2006) Added value of a physician-and-nurse-directed heart failure clinic. Results from the DEAL-HF study. Heart 93(7):819–825

    Article  PubMed  Google Scholar 

  29. Pearson S et al (2006) Prolonged effects of a home-based intervention in patients with chronic illness. Arch Intern Med 166(6):645–650

    Article  PubMed  Google Scholar 

  30. Stewart S, Pearson S, Horowitz JD (1998) Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Arch Intern Med 158(10):1067–1072

    Article  CAS  PubMed  Google Scholar 

  31. Bergqvist M et al (2008) A nurse-led intervention for identification of drug-related problems. Eur J Clin Pharmacol 64(5):451–456

    Article  PubMed  Google Scholar 

  32. Sjöqvist F, Janus Webb (2003) Janus Web Application. http://213.179.0.133:8080/ddb/interactions. Accessed between July 2006 and December 2006

  33. National Board of Health and Welfare (Socialstyrelsen) (2003) Indikatorer för utvärdering av kvaliteten i äldres läkemedelsterapi- Socialstyrelsens förslag [Indicators for evaluation of the quality of drug use in the elderly (in Swedish)]

  34. WHO (1972) International drug monitoring: the role of national centres. Tech Rep Ser 498

  35. Bain KT, Weschules DJ (2007) Medication inappropriateness for older adults receiving hospice care: a pilot survey. Consult Pharm 22(11):926–934

    PubMed  Google Scholar 

  36. Corsonello A et al (2005) Concealed renal insufficiency and adverse drug reactions in elderly hospitalized patients. Arch Intern Med 165(7):790–795

    Article  PubMed  Google Scholar 

  37. Fields W et al (2008) Reducing preventable medication safety events by recognizing renal risk. Clin Nurse Spec 22(2):73–78 quiz 79–80

    Article  PubMed  Google Scholar 

  38. Akbari A et al (2004) Detection of chronic kidney disease with laboratory reporting of estimated glomerular filtration rate and an educational program. Arch Intern Med 164(16):1788–1792

    Article  PubMed  Google Scholar 

  39. Swedko PJ et al (2003) Serum creatinine is an inadequate screening test for renal failure in elderly patients. Arch Intern Med 163(3):356–360

    Article  CAS  PubMed  Google Scholar 

  40. Annells M, Koch T (2002) Faecal impaction: older people’s experiences and nursing practice. Br J Community Nurs 7(3):118–126

    PubMed  Google Scholar 

  41. Turner MD, Ship JA (2007) Dry mouth and its effects on the oral health of elderly people. J Am Dent Assoc 138(Suppl):15S–20S

    PubMed  Google Scholar 

  42. O’Brian C (2008) Nausea and vomiting. Can Fam Physician 54:861–863

    Google Scholar 

  43. Wald A et al (2007) The burden of constipation on quality of life: results of a multinational survey. Aliment Pharmacol Ther 26(2):227–236

    Article  CAS  PubMed  Google Scholar 

  44. Syed HTM (2007) How do you manage constipation in the long-term care setting? Ann Long-Term Care 15(4):1524–7929

    Google Scholar 

  45. Backstrom M, Mjorndal T, Dahlqvist R (2002) Spontaneous reporting of adverse drug reactions by nurses. Pharmacoepidemiol Drug Saf 11(8):647–650

    Article  CAS  PubMed  Google Scholar 

  46. Ulfvarson J, Mejyr S, Bergman U (2006) Nurses are increasingly involved in pharmacovigilance in Sweden. Pharmacoepidemiol Drug Saf 16(5):532–537

    Article  Google Scholar 

Download references

Acknowledgments

This study was financially supported by grants from Main applicant (ALF) and the Drug & Therapeutics Committee. The authors wish to thank the participating nurses at Södersjukhuset, the Department of Internal Medicine, Ward 26, for making this study possible. We also wish to thank Associate Professor Johan Fastbom for computer program support and data preparation.

Author information

Authors and Affiliations

  1. Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden

    Monica Bergqvist & Eva Andersén Karlsson

  2. Department of Neurobiology, Care Sciences, and Society Division of Nursing, Karolinska Institutet, Stockholm, Sweden

    Johanna Ulfvarson

Authors
  1. Monica Bergqvist
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johanna Ulfvarson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eva Andersén Karlsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Monica Bergqvist.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bergqvist, M., Ulfvarson, J. & Andersén Karlsson, E. Nurse-led medication reviews and the quality of drug treatment of elderly hospitalized patients. Eur J Clin Pharmacol 65, 1089–1096 (2009). https://doi.org/10.1007/s00228-009-0728-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-009-0728-2

Keywords

Search

Navigation