title: [Inappropriate prescription and administration of medications in 10 nursing homes in Alsace, France].
abstract: BACKGROUND
  Medication care is a complicated process in nursing homes. The aim of the study was to offer an overview of inappropriate medication prescription and administration practices in nursing homes in Alsace in order to propose improvement actions to remedy the weaknesses identified.
  
  
  METHODS
  This study was conducted prospectively in 10 nursing homes under contract with community pharmacies in Alsace. The practices of prescription were examined to determine the prevalence of potentially inappropriate medications, inappropriate and contraindicated medication associations. Crushing and opening practices were also assessed, daily treatment costs were calculated.
  
  
  RESULTS
  Two hundred and eighty-four residents were included (age: 87.1 ± 5.6 years). The average number of drugs per resident was 8.1 ± 4.0 (daily treatment cost: 4.19 ± 5.21 €). On average, 1.5 drugs ± 1.4 per prescription were considered as potentially inappropriate (daily treatment cost: 0.49 ± 0.76 €). The contraindication associations concerned 8 % of prescriptions and involved potentially inappropriate drugs in 60 % of cases. Inappropriate associations mainly concerned nervous system drugs. Thirty-three residents were taking more than 2 psychotropic drugs; 23 had more than one benzodiazepine. Regarding drug administration, practices differed from one nursing home to another. Crushing was performed in 8 nursing homes. It concerned 20 residents (7 %) and 69 drugs. In 50 %, the crushing decision was made by nurses without physician or pharmacist supervision. Fifty-seven percent of crushed drugs had a formulation which did not allow crushing (n=39 drugs). The analysis of those items led to the proposal of improvement actions.
  
  
  CONCLUSIONS
  This study pointed out inappropriate medication practices. Tracking tools for inappropriate clinical practices could be operated by physicians, pharmacists and nursing teams through coordinated multidisciplinary approaches.
authors.affiliation: OMEDIT d'Alsace, 67084 Strasbourg, France.
authors.forename: A
authors.initials: A
authors.lastname: Rousseau
authors.affiliation: OMEDIT d'Alsace, 67084 Strasbourg, France.
authors.forename: M C
authors.initials: MC
authors.lastname: Rybarczyk-Vigouret
authors.affiliation: Pôle de gériatrie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France.
authors.forename: T
authors.initials: T
authors.lastname: Vogel
authors.affiliation: Service de gériatrie et de réadaptation gériatrique, centre hospitalier universitaire vaudois, 1011 Lausanne, Suisse.
authors.forename: P-O
authors.initials: PO
authors.lastname: Lang
authors.affiliation: OMEDIT d'Alsace, 67084 Strasbourg, France; Service de pharmacie, hôpitaux universitaires de Strasbourg, laboratoire HuManiS (EA 7308), faculté de pharmacie, université de Strasbourg, 67091 Strasbourg, France. Electronic address: bruno.michel@chru-strasbourg.fr.
authors.forename: B
authors.initials: B
authors.lastname: Michel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004304:Dosage Forms; D016527:Drug Costs; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008508:Medication Errors / Q000191:economics / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data*; D015995:Prevalence
chemical_list: D004304:Dosage Forms
keywords: Crushed drug; Elderly; Médicament écrasé; Médicaments potentiellement inappropriés; Nursing homes; Personne âgée; Potentially inappropriate medication; Établissement médico-social