Clinical informatics monitoring tool helps reduce adverse drug events in nursing home settings
Research Activities, January 2012, No. 377
In nursing homes, 40 percent of residents use at least nine different medications, and adverse drug events (ADEs) are common. Yet many ADEs are preventable if adequate medication monitoring is performed. The use of the Geriatric Risk Assessment MedGuide (GRAM), a clinical informatics tool that implements prospective monitoring plans, markedly reduced the risk of potential delirium in newly admitted and long-stay nursing home residents, according to a new study. Potential hospitalizations and deaths due to ADEs and mortality were also reduced, but the effect was weaker in longer-stay residents. There was no effect of the monitoring system on the incidence of falls.
Kate L. Lapane, Ph.D., of Virginia Commonwealth University, worked with Janice Feinberg, Pharm.D., J.D., of the American Society of Consultant Pharmacists Foundation that developed the tool, and colleagues to test the GRAM software in 26 nursing homes during 2003-2004. This technology was designed to assist health care professionals with expertise in geriatric pharmacotherapy in problem identification when evaluating complex medication regimens of older adults. It was used to engage consultant pharmacists and nursing staff to identify residents at risk for delirium and falls, implement proactive medication monitoring plans as appropriate, and provide reports to assist consultant pharmacists in conducting the medication regimen review.
The researchers point out that systems using information technology to improve the monitoring stage of the medication-use process are sparse. How to pay for such services has yet to be determined, because information technology adoption in nursing homes has been slow. This study was supported in part by the Agency for Healthcare Research and Quality (HS11835).
See "Effect of a pharmacist-led multicomponent intervention focusing on the medication monitoring phase to prevent potential adverse drug events in nursing homes," by Dr. Lapane, Carmel M. Hughes, Ph.D., Lori A. Daiello, Pharm.D., and others in the Journal of the American Geriatric Society 59, pp. 1238-1245, 2011.