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4CPS-105 Medicines optimisation for patients in a nursing home
  1. FM Ferrer Soler1,
  2. CM Cuadros Martínez1,
  3. P López Sánchez1,
  4. MV Peraza Pérez2,
  5. JJ Márquez Nieves1
  1. 1Hospital General De Tomelloso, Pharmacy, Tomelloso, Spain
  2. 2Gerencia De Atención Integrada De Tomelloso, Primary Care, Argamasilla De Alba, Spain


Background and Importance Inappropriate prescribing is associated with increased morbidity and mortality, especially in the elderly. It is necessary to find tools to improve the care of these patients.

Aim and Objectives The objective was to evaluate the results of a medication review program in nursing home (NH) patients, analysing the acceptance of pharmacotherapeutic recommendations and identifying the most frequent interventions and the pharmacological groups involved.

Material and Methods Prospective-multidisciplinary intervention study carried out between 03/07/23 and 25/09/23 using a treatment review program for institutionalised patients in NH.

All institutionalised patients were included. Patients who died were excluded. Sex, age, NG-tube, creatinine, blood pressure, main diagnoses, and drugs prescribed were collected. Using the software Checkthemeds®,the pharmacist reviewed treatments, preparing a report that included the problems detected and suggestions: Start drug, stop drug, substitution, dose change, or monitoring. Therefore, the NH doctor could assess the need for treatments modifications.

Number of initial and final drugs, interventions performed and accepted, and type of interventions were analysed.

The descriptive analysis was performed using Microsoft Excel® (percentages, means, standard deviations).

Results A total of 46 patients (28 women), mean age 85.95 years [7.96], were reviewed. Two were excluded due to death. A total of 526 drugs were analysed. Each patient was prescribed an average of 11.95 [4.45]. In 5 patients no recommendation was made. Eighty-nine recommendations were made, 46 (51.7%) were accepted, being the recommendations: 2 new medicines suggestions, none accepted; 75 medication discontinuations, 40 accepted; 5 therapeutic substitutions, 3 accepted; 6 dose modifications, 2 accepted and 1 monitoring, 1 accepted. The final number of drugs was 11.02 [4.21]. Drugs involved were mainly Central Nervous System depressants (34 recommendations); Proton Pump Inhibitors (20); and antianemic preparations (12). The main cause of non-acceptance was the reluctance of relatives to modify antipsychotic therapies.

Conclusion and Relevance The medication review program for NH residents, through the collaboration of a hospital pharmacist and a primary-care physician, optimises the pharmacotherapy of institutionalised patients. The interventions of the multidisciplinary team provide great value in deprescribing, reducing the number of drugs used, and are a valuable tool to improve the safety and effectiveness of treatments.

Conflict of Interest No conflict of interest.

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