Nurse-led medication reviews and the quality of drug  treatment of elderly hospitalized patients.
OBJECTIVE
To evaluate if nurses after receiving training in clinical pharmacology can improve the quality of the drug therapy in elderly hospitalized patients.


METHODS
Nurses were given a 1-day training in clinical pharmacology to identify drug-related problems (DRPs).All patients admitted to the ward aged 65 or more were studied. Patients at the same ward before the intervention were considered as control group. Outcome variables were re-hospitalized 3 months from discharge, drug-related readmissions, the proportion of inappropriate drug use (IDU), and DRPs found by the nurses.


RESULTS
Of 460 patients (250 intervention group and 210 in the control group) 38 and 36%, respectively, had at least one re-admission to hospital (p=0.86) and 24% of the patients died. Eighteen and 17% (43/37), respectively, used one or more inappropriate drug (p 0.90). The nurses found 86 clinically significant DRPs not detected by the usual care. A substantial part of the DRPs detected by the nurses were revealed with assistance of Symptoms Assessment Form (SYM). There were no statistical difference in the number of drug-related re-admissions between the groups, 14/16, respectively, (p=0.40).


CONCLUSIONS
Nurses are able to detect a high proportion of clinically relevant DRPs not detected by the usual care and thereby increase the quality of the drug treatment in elderly hospitalized patients. Our study showed no effect on re-hospitalization or IDU. By using a SYM nurses can find DRPs that computer-based decision support systems miss.
Bergqvist
Monica
M
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden. monica.bergqvist@sodersjukhuset.se
Ulfvarson
Johanna
J
Karlsson
Eva Andersén
EA
D000368:Aged; D000369:Aged, 80 and over; D004358:Drug Therapy / Q000592:standards; D017723:Drug Utilization Review / Q000379:methods*; D004506:Education, Nursing; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D024802:Nurse's Role; D009726:Nurses; D010351:Patient Discharge; D010359:Patient Readmission; D010600:Pharmacology / Q000193:education