Nurse-led interventions to minimise adverse drug reactions for older adults in care homes.
Principal / Lead Investigator
Andrew Carson-Stevens, Cardiff University
- Sue Jordan (Swansea University),
- Joyce Kenkre (PRIME, USW),
- Jamie Hayes (WeMeReC),
- Sue Bale (Aneurin Bevan UHB),
- Tim Banner (Consultant Pharmacist),
- Alan Watkins (Statistician, Swansea University),
- Jeff Round (Lecturer in Health Economics, University of Bristol),
- Hayley Prout (Cardiff University)
Type of study
Evaluation of the implementation of an intervention.
Adverse drug reactions (ADRs) are a major outcome of patient safety incidents occurring in primary care, mainly due to inadequate monitoring, communication or decision-making.
Shortcomings in medication management in care homes were highlighted by the Andrews’ and Flynn Reports in Wales, and were followed by calls for action. As many as 90% of patients in care home are prescribed >4 medicines in South Wales, higher than elsewhere (65.8%), and would benefit from a systematic approach to medicines management.
We propose an analysis of polypharmacy-related patient safety incidents involving older adults reported to a national database. A team comprised of a pharmacist, a doctor and a nurse will be trained to analyse safety reports to develop a logic model that will form the basis of a new intervention to monitor and manage medicines management to identify ADRs for older adults in care homes.
The intervention will be developed, digitised and tested like the existing successful intervention for mental health medicines that has proven a nurse-led approach to medicines management to be effective. Evidence for pharmacist-led interventions is equivocal or low quality: therefore, we use a multidisciplinary strategy, centring on nurses in care homes. This intervention allowed nurses to identify problems that could be addressed by changes in care and discussion with prescribers, benefitting patients and improving the service. On a single page (screen, in the digitised version), nurses can share their findings with both prescribers and pharmacists reviewing medications. It facilitates multi-disciplinary decision-making by providing key information:
- Previously unrecognised or unmonitored problems
- Problems that might be alleviated if medication doses, formulations or timings were changed
- Possible causes, including prescribed medicines, of problems identified.
Research and development is now needed to: a) be inclusive of commonly prescribed medicines to older adults; b) to be tested in a diverse range of care home contexts, including in socio-economically deprived geographical areas and those under special measures. However, if successful the tool could be developed for other areas of practice.
Who is the study sponsor?
Aneurin Bevan UHB
UKCRN portfolio number
Total grant value
How could this research potentially benefit patients?
Polypharmacy, the use of multiple or inappropriate medications, has the potential to harm older adults by causing cognitive impairment, falls, and hospitalisations. Nurse-led interventions to review medicines have demonstrated improved care quality by identifying serious adverse drug reactions (ADRs).