Study shows inappropriate drug scheduling. (column)

The inappropriate scheduling and administration of medications in a geriatric nursing home was studied by a consultant pharmacist in a 72-bed geriatric nursing home over a two-year period. Noted were 24 documented cases of inappropriate drug scheduling, which concerned antibiotics (12) given with meals rather than before meals; or being dosed over 4- rather than 8-hour intervals, antacids with meals and medications, rather than 1 to 2 hours after meals (6), and antipsychotics/antidepressants given 3 to 4 times daily or at inappropriate times (6).

The primary reason for the scheduling errors was noted to be the lack of a central pharmacist who both dispensed and scheduled the medication orders. The use of 8 separate pharmacies with an individual prescription system, rather than modified unit-dose could have prevented virtually all of the inappropriate schedulings of drugs. A 100% compliance rate with consultant pharmacists recommended changes was noted.

Introduction

Previous studies in this drugrelated problem series have focused on medication errors, relative contraindications and adverse reactions and interactions with drugs, nutritional assessment, socioeconomic considerations, drug duplication, questionable drug efficacy, therapeutic need for drug therapy, and appropriate use of lab tests. (See Pharmacy Briefs columns in November/December '86 through May/June '88, Nursing Homes.) The purpose of the study discussed in this column was to assess the appropriateness of drug scheduling and administration by provider pharmacists and charge nurses in a geriatric long-term care facility over a two-year period. Specific study objectives were to: 1. Determine the appropriate scheduling of medications from dispensing to administration, and documentation in the medication administration record (MAR); and

2. Document the outcomes of inappropriate scheduling of drugs and follow-up on recommended scheduling changes.

Methods and Materials

All patients in a 72-bed skilled nursing facility served by 6 physicians, 8 provider pharmacists, and 1 consultant pharmacist were evaluated over a two-year period by intensive monthly drug regimen review conducted by a doctoral-level consultant clinical pharmacist.