Background Optimising drug treatment is an essential part of caring for older people. Due to the comorbidity and frailty of this population, pharmacologic treatment should be individualised and reviewed to ensure the benefits for patients. The involvement of pharmacists through interventions has led to positive outcomes in different settings, although there is not a broad experience in nursing homes.

Purpose To optimise pharmacotherapy through pharmaceutical interventions in geriatric patients in nursing homes within a pharmaceutical care programme.

Materials and methods In the Prescription Quality Unit (PQU), two pharmacists provide training and support to several care teams in nursing homes. They review clinical reports and medication plans of patients, using an algorithm developed by the pharmacy service of our institution according to criteria of efficacy, safety, efficiency and standards in geriatrics. The problems detected and pharmaceutical interventions are communicated to the physicians in reconciliation meetings.

Results A prospective study was undertaken during August and September 2013. Medication plans of 62 patients (mean age 84 years) were reviewed. 211 interventions were made with a 78% acceptance rate by physicians. These interventions were related to:

• Reconciliation 24%

• Drug omission 19%

• Drug not indicated 15%

• Drug inappropriate in geriatrics 15%

• Dosage error 7%

• Duplication 6%

• Contraindication 5%

• Low intrinsic value drugs 2%

• Length of treatment 1%

In the 22% of the interventions not accepted, the main reasons were: specialist follow-up, the change had been already made unsuccessfully, to prioritise the stability of the patient over the recommendation.

Conclusions There is a high incidence of medicines problems in nursing homes. The work of pharmacists has a high value in improving drug use in these settings. In parallel, it encourages communication and collaboration between professionals.

No conflict of interest.