Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #106484

Janice L. Feinberg, PharmD, JD, American Society of Consultant Pharmacists Research & Education Foundation, One East Delaware Place, Suite 27H, Chicago, IL 60611, 312-202-9914, jfeinberg@ascp.com and Kate L. Lapane, PhD, Department of Gerontology, Brown University, 171 Meeting Street, Box GB-222, Providence, RI 02912.

SESSION ABSTRACT

In nursing facilities, the average resident uses six medications and 20% use at least 10 medications. Given the medical complexity of nursing facility residents, multiple medications may be clinically appropriate and may indeed optimize functional status. However, changes in pharmacokinetics and pharmacodynamics, as well as multiple co-morbid conditions, make older persons more vulnerable to adverse drug effects (ADE).

A 2000 study of residents in 18 Massachusetts nursing facilities estimated 1.89 ADEs per 100 resident-months, one-half were deemed preventable. Of preventable ADEs, 70% occurred at the monitoring stage of the medication use process. The Office of the Inspector General report, Prescription Drug Use in Nursing Homes, states that ". . .patients may be experiencing unnecessary adverse medication reactions as a result of inadequate monitoring of medications" and recommends that "HCFA should require pharmacists' direct input to achieve optimal clinical outcomes for residents."

Most efforts to reduce medication errors have focused on prescribing, dispensing, or medication administration; few have targeted the monitoring stage of the medication use process. This session presents two research projects studying novel approaches for pharmacist intervention to reduce the risk for ADEs at the monitoring stage of the medication use process, which fosters early recognition of potential ADEs that can be avoided, managed, or reversed.

Learning Objectives: At the conclusion of this presentation, attendees will be able to

• Understand the multiplicity of issues related to medication-related problems including clinical, organizational, staff, and resident factors;
• Recognize the role of job satisfaction, work stressors, and communication among health care providers and their impact on patient safety;
• Describe the use of clinical software to improve the monitoring stage of the medication use process;
• Describe an innovative model of pharmacist intervention that includes prospective review, direct communication with the prescriber, pharmacist assessment of the patient, and formalized pharmaceutical care planning for elderly patients at highest risk for medication-related problems to improve medication safety.

Keywords: Drug Safety, Nursing Homes

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commertial supporters WITH THE EXCEPTION OF the American Society of Consultant Pharmacists Research & Education Foundation, which owns the copyright on the clinical software used in the research project..