Quality of prescribing in Belgian nursing homes: an electronic assessment of the medication chart

Abstract

Objective: To develop a computerized assessment tool for monitoring the quality of prescribing in Belgian nursing homes.

Design: In a observational cross-sectional study of the medication charts of nursing home residents, potentially inappropriate medication (PIM) was investigated using three scoring systems for the elderly (Beers, ACOVE, BEDNURS) complemented with a list of drug-drug interactions.

Setting: A representative stratified sample of Belgian nursing homes (n = 76).

Participants: A random sample of nursing home residents with a complete data set (n = 1730) excluding palliative care patients.

Main outcome measure: A combination of PIM scores to assess inappropriate, under- and overprescribing.

Results: Included residents had a mean age of 85, 78% were female. They used a mean of 7.1 chronic medications. Most PIMs were detected by the application of the ACOVE criteria for underprescribing with 58% of patients having at least one PIM. Using the BEDNURS and the Beers criteria, at least one PIM was noticed in 56 and 27% of patients, respectively. Patients' characteristics showing a positive relationship with the PIM score were age, female gender, amount of clinical and nursing care problems, number of prescriptions and the use of psychotropic drugs (multiple regression analysis R(2) = 0.332).

Conclusions: In Belgian nursing homes, the observed high level of drug utilization was associated with potentially inappropriate prescribing. The development of a combined assessment tool and the implementation of a computerized monitoring system of PIMs is highly recommended to improve the quality of prescribing.

Keywords: drug utilization; elderly; inappropriate prescribing; nursing home; potentially inappropriate medication; prescribing quality.