title: Reduction of inappropriate medications among older nursing-home residents: a nurse-led, pre/post-design, intervention study.
abstract: BACKGROUND
  Medication-related problems are common in the growing population of older adults and inappropriate prescribing is a preventable risk factor. Explicit criteria such as the Beers criteria provide a valid instrument for describing the rate of inappropriate medication (IM) prescriptions among older adults.
  
  
  OBJECTIVE
  To reduce IM prescriptions based on explicit Beers criteria using a nurse-led intervention in a nursing-home (NH) setting.
  
  
  METHODS
  The pre/post-design included IM assessment at study start (pre-intervention), a 4-month intervention period, IM assessment after the intervention period (post-intervention) and a further IM assessment at 1-year follow-up.
  
  
  METHODS
  204-bed inpatient NH in Bern, Switzerland.
  
  
  METHODS
  NH residents aged ≥60 years.
  
  
  METHODS
  The intervention included four key intervention elements: (i) adaptation of Beers criteria to the Swiss setting; (ii) IM identification; (iii) IM discontinuation; and (iv) staff training.
  
  
  METHODS
  IM prescription at study start, after the 4-month intervention period and at 1-year follow-up.
  
  
  RESULTS
  The mean ± SD resident age was 80.3 ± 8.8 years. Residents were prescribed a mean ± SD 7.8 ± 4.0 medications. The prescription rate of IMs decreased from 14.5% pre-intervention to 2.8% post-intervention (relative risk [RR] = 0.2; 95% CI 0.06, 0.5). The risk of IM prescription increased nonstatistically significantly in the 1-year follow-up period compared with post-intervention (RR = 1.6; 95% CI 0.5, 6.1).
  
  
  CONCLUSIONS
  This intervention to reduce IM prescriptions based on explicit Beers criteria was feasible, easy to implement in an NH setting, and resulted in a substantial decrease in IMs. These results underscore the importance of involving nursing staff in the medication prescription process in a long-term care setting.
authors.affiliation: Division of Geriatrics, Department of General Internal Medicine, Inselspital and University of Bern, Bern, Switzerland.
authors.forename: Eva
authors.initials: E
authors.lastname: Blozik
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Born
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Stuck
authors.forename: Ulrich
authors.initials: U
authors.lastname: Benninger
authors.forename: Gerhard
authors.initials: G
authors.lastname: Gillmann
authors.forename: Kerri M
authors.initials: KM
authors.lastname: Clough-Gorr
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006707:Homes for the Aged / Q000592:standards; D006801:Humans; D057970:Inappropriate Prescribing / Q000379:methods*; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009735:Nursing Homes / Q000592:standards