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4CPS-227 Pharmaceutical review and pharmaceutical intervention in a nursing home to enhance the medication management of residents
  1. E Castex1,
  2. V Frapart2,
  3. L Bertin3,
  4. J Siauve3,
  5. B Forget3
  1. 1Chu Amiens Picardie, Hospital Pharmacy, Amiens, France
  2. 2Ch De Montreuil Sur Mer, Ehpad Les Pléiades, Montreuil Sur Mer, France
  3. 3Ch De Montreuil Sur Mer, Hospital Pharmacy, Montreuil Sur Mer, France


Background and Importance Geriatrics is particularly concerned by iatrogenic medication accidents, especially in nursing homes (NH) where residents are often polypathological and can spend months without treatment revaluation.

Aim and Objectives Enhance the medication management of residents in NH.

Material and Methods Pharmaceutical review (PR) conducted during multidisciplinary meetings, based on computerised prescriptions, biological and clinical data from the electronic patient record, and then compared to national references. Subsequently, the pharmaceutical interventions (PI) carried out are quantified and analysed.

The anticholinergic score (AS) was calculated for each resident using two assessment scales: the ACB (Anticholinergic Cognitive Burden) and CIA (Cholinergic Drug Burden) scale.

Results Among 71 residents, 142 PIs were carried out, with a 58.5% acceptance rate (n=83) of the physician, averaging two PIs per resident.

Most PIs (33.1%; n=47) concerned unsuitable medication for the elderly, with a 61.7% acceptance rate. Initially, 62 potentially inappropriate medications (PIMs) were identified for 38 residents, averaging 0.87 PIMs per resident. After the PR: only 33 PIMs remaining for 25 residents, averaging 0.47 PIMs per patient.

A high AS was found for 20 residents. Twenty-six PIs (18.3%) with a 42.3% acceptance rate (n=11) were performed in attempts to reduce these AS: which resulted in a decrease from five residents with a significant ACB score to three, and from 15 residents with a high CIA score to 11.

Seventy-four PIs (52.1%) were related to nervous system drugs. After a multidisciplinary discussion with geriatricians and psychiatrists, 43.2% of these PIs (n=32) were accepted. Substitution was the most recommended type of PI (n=38), resulting in a modest reduction in psychotropic drug consumption (9.7%).

Conclusion and Relevance This NH accommodates residents with psychotic disorders, behavioural issues, and intellectual disabilities, which explains the low acceptance rate of PIs related to psychotropic drugs and the difficulty in reducing the AS. Beyond the acceptance of PIs, the PR enables the coordinating physician to re-evaluate the overall therapeutic management of residents, and helps mitigate the underuse, overuse and misuse of medications, which are quite common in geriatrics.

Conflict of Interest No conflict of interest.

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