gms | German Medical Science

17th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

25.11. - 26.11.2010, Osnabrück

Drug-related problems and adverse events in nursing homes

Meeting Abstract

  • corresponding author Petra Thürmann - Helios Klinikum Wuppertal, Philipp Klee-Institut für Klinische Pharmakologie, Universität Witten/Herdecke, Wuppertal, Germany
  • Frank Hanke - GeroPharmcare GmbH, Köln, Germany
  • Simone Bernard - Helios Klinikum Wuppertal, Philipp Klee-Institut für Klinische Pharmakologie, Universität Witten/Herdecke, Wuppertal, Germany
  • Friederike Schröder - Institut für Klinische Pharmazie, Universität Bonn, Germany
  • Sven Schmiedl - Helios Klinikum Wuppertal, Philipp Klee-Institut für Klinische Pharmakologie, Universität Witten/Herdecke, Wuppertal, Germany
  • Stefan Wilm - Institut für Allgemeinmedizin und Familienmedizin, Universität Witten/Herdecke, Witten, Germany
  • Marcus Redaelli - Institut für Allgemeinmedizin und Familienmedizin, Universität Witten/Herdecke, Witten, Germany
  • Ulrich Jaehde - Pharmazeutisches Institut, Klinische Pharmazie, Universität Bonn, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 17. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Osnabrück, 25.-26.11.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10gaa21

DOI: 10.3205/10gaa21, URN: urn:nbn:de:0183-10gaa211

Published: November 22, 2010

© 2010 Thürmann et al.
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Outline

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Introduction: Nursing home residents are characterised by very old age, multimorbidity and subsequent polypharmacy.

As demonstrated in previous investigations, this constellation is associated with numerous drug-related problems and adverse drug-related events (Gurwitz et al, Amer J Med 2005). We aimed to 1) investigate drug-related problems (DRPs) and adverse events (AEs) in selected nursing homes in North Rhine-Westphalia and 2) to establish an intervention.

Methods: In the first phase drug-related problems (Morimoto et al, Qual Saf Health Care 2004) and drug-associated adverse events (AEs) were detected by intensified monitoring over 4 weeks in selected nursing homes. After approval by the ethics committee, written informed consent was obtained from residents or their responsible caregivers. Two clinical pharmacists experienced in geriatric pharmacotherapy screened medical documentation, nurses’ notes and hospital discharge letters for potential DRPs and AEs using pre-defined trigger criteria and documented in an ACCESS database. All potential cases were discussed and their causality with drug treatment evaluated in a team consisting of a geriatrician, clinical pharmacologists and clinical pharmacist. Based on the results a multi-disciplinary intervention was implemented in 4 nursing homes involving the prescribing general practitioners, nurses and pharmacists.

Results: 11 nursing homes (1046 residents) participated, of which 789 (74.6%) could be included. 102 AEs were detected over the 30 days observation period, giving a 30-days-prevalence of 12.0 AEs/100 resident months and an incidence of 8.11 AEs/100 resident months. 31% of AEs occurred in the gastro-intestinal tract, 25% were neurological disorders. 49% of AEs were grade 2 and 27% grade 3 according to CTCAE, 58% of AEs were deemed preventable. The subsequent intervention was carried out in 4 of the participating nursing homes.

Discussion and conclusion: The frequency and type of AEs in nursing homes observed in our study is in accordance with findings from previous surveys. The intervention implemented required personal resources especially from nursing homes. The feasibility will be evaluated by all participating professions.

This study was funded by the German Ministry of Health.