Objectives To establish a medication review programme in geriatric patients in nursing homes.

Methods 70 nursing homes, attended by 8 healthcare teams; two consultant pharmacists provide training and support. Prospective study, conducted between August and December 2013, consisting in patients medication profile review, using an algorithm developed by the Pharmacy Department. Drug-related problems (DRP) were communicated to physicians and documented using the Pharmaceutical Care Network Europe scheme. Medication appropriateness index (MAI) score was calculated before and after the pharmacist's interventions.

Results Medication profiles of 127 patients (mean age 84 years) were reviewed. 424 DRP were detected, the majority related to potential adverse drug events. Pharmacists’ interventions/recommendations were made mainly at prescription level. Lack of indication for the drug prescribed in the clinical record was a recurrent problem, thus indicating a somewhat poor quality in these records. Potentially inappropriate drug prescription was also a common problem (17.6%). Cardiovascular, alimentary tract and metabolism and nervous system drugs were those with more DRP. Degree of acceptance of interventions was 80%. The principal cause of non-acceptance was when the drug has been prescribed by a specialist. Number of drugs per patient dropped from 10.3 to 9.5, and the mean MAI score dropped from 5.4 to 1.3.

Conclusions The incorporation of consultant pharmacists at nursing home level has led us to know the quality of prescription and the DRP. We have established a multidisciplinary team that works for the improvement of drug use.