title: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  A representative stratified sample of Belgian nursing homes (n = 76).
  
  
  METHODS
  A random sample of nursing home residents with a complete data set (n = 1730) excluding palliative care patients.
  
  
  METHODS
  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.
authors.affiliation: CDE, R3.29, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium. monique.elseviers@ua.ac.be.
authors.forename: Monique M
authors.initials: MM
authors.lastname: Elseviers
authors.forename: Robert R
authors.initials: RR
authors.lastname: Vander Stichele
authors.forename: Luc
authors.initials: L
authors.lastname: Van Bortel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006707:Homes for the Aged / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009735:Nursing Homes / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*
keywords: drug utilization; elderly; inappropriate prescribing; nursing home; potentially inappropriate medication; prescribing quality