gms | German Medical Science

20th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

05.12. - 06.12.2013, Düsseldorf

A multi-center prospective interventional study for improving medication safety in German nursing homes (AMTS-AMPEL)

Meeting Abstract

  • corresponding author presenting/speaker Simone Bernard - Universität, Witten/Herdecke, Germany
  • Stephanie Pietzyk - Universität, Witten/Herdecke, Germany
  • Melanie Kulick - Universität, Bonn, Germany
  • Susanne Nehls - Universität, Rostock, Germany
  • Marcus Redaèlli - Universität, Düsseldorf, Germany
  • Anja Wollny - Universität, Rostock, Germany
  • Femke Böhmer - Universität, Rostock, Germany
  • Attila Altiner - Universität, Rostock, Germany
  • Bernd Drewelow - Universität, Rostock, Germany
  • Stefan Wilm - Universität, Düsseldorf, Germany
  • Ulrich Jaehde - Universität, Bonn, Germany
  • Petra Thürmann - Universität, Witten/Herdecke, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 20. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Düsseldorf, 05.-06.12.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13gaa02

doi: 10.3205/13gaa02, urn:nbn:de:0183-13gaa022

Published: November 25, 2013

© 2013 Bernard et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: The population of elderly people is growing in all industrialised countries, described as the “demographic change”. Although the majority of frail, elderly people, requiring nursing care, are living at home and care is provided by their (usually female) relatives, the total number of nursing home residents is steadily increasing [1]. Rising cost and low personnel resources are barriers preventing appropriate care. Our health care system, originally designed to accommodate patients with acute health problems must be restructured to enable adequate care for people with multiple chronic diseases. Therefore, health care professionals must firstly recognise this new requirement, and secondly adapt their inter-professional communication and interactions.

The presence of multiple chronic conditions usually results in polypharmacy, where nursing home residents usually receive more than five different medications per day plus a number of drugs given on demand. This leads inadvertently to drug interactions, adverse effects, prescribing cascades, and adverse drug-related events (ADEs) [2], [3]. According to a previous study, 7.87 ADEs per 100 nursing home resident months (NHRM) occur in German nursing homes, many of them are preventable and can be recognised early by nurses [4]. Therefore, new and particularly inter-professional approaches must be developed to increase medication safety in nursing homes.

It is the aim of this project to increase medication safety and reduce ADEs in nursing homes by i) increasing the awareness and knowledge about ADEs and ii) creating more efficient structures between different health care professionals. The feasibility of the planned intervention has been tested in the previous project [2].

Materials and Methods: This prospective intervention study will include approximately 1000 residents in at least 15 nursing homes in North Rhine-Westphalia and Mecklenburg-West Pomerania [5].

ADE detection, documentation and evaluation will be carried out by experienced pharmacists in a standardized manner as described previously [2]. Access to the field will involve firstly, primary care physicians, who treat nursing home residents. After their declaration of interest for the study, the nursing homes will be approached. This procedure has been chosen because of previous experiences, where primary care physicians could not be motivated when the nursing homes were contacted prior to their involvement.

Modified instruments like a medication safety reminder card, recommendations of the PRISCUS-list for potentially inappropriate medications [6], and standardized forms will serve the health care professionals as a basis for interactive collaboration. Moreover, training for all professionals involved, i.e. nurses, pharmacists, and physicians, will take place in the long-term care facilities. Medication safety teams consisting of pharmacists and nursing staff will play a central role. In regional quality circles and general practitioner networks, ADEs and prescribing problems will be discussed by pharmacists together with physicians.

Primary endpoint is the prevalence of ADEs per 100 NHRM; comparisons will be performed before the intervention, and 6 months and 12 months after the intervention. Secondary endpoints include the incidence of ADE and presence of inappropriate medications (drug-drug interactions, PRISCUS-PIM). Moreover, the performance of the medication safety teams will be evaluated in a qualitative and quantitative way. During the course of the study, satisfaction of the different health care professionals will be assessed by standardized questionnaires.

Results: The recruitment of primary care physicians and nursing homes is ongoing. Competing projects and lack of personnel resources are currently hampering the involvement of nursing homes. However, an increased awareness of the problems and general interest to intensify the communication between professionals were observed.

Some of the instruments from the previous project were improved, like the medication safety reminder card. In addition, communication instruments such as fax forms were reworked and subjected to a pre-test. The contents of the training modules for pharmacists, nurses, and physicians were finalised.

Further information can be found at (funded by the German Ministry of Health, IIA5-2512FSB503).


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