Medication use in rest and nursing homes in Belgium. - KCE

50 Medication use in Nursing Homes KCE reports 47
Institution Level
gradations 1, 2 and 3 (positive or negative) respectively reflected a small, moderate or
serious impact on the quality of provided care. The individual domain scores were
summed to a total score for both the wards and the nursing home management. The
total score, which is a sum-score of all the different domain scores, reflects the quality
of the medication process in the nursing home.
Table 3.1: Domains of medication management systems
Pharmacy Aspects of delivery of medications from the pharmacy to
the nursing home
Formulary Availability of the formulary in the institution
Medication Management The procedures pertaining to quality management and
evaluation
Ward Level
Information The extent to which medication related information is
given or easily available for residents and nursing staff
Administration The extent to which the administration of medicines to
residents by nurses is organized and controlled
Preparation The extent to which the preparation of the
administration of medicines (reading from the
medication chart and fetching from the drug stock) is
organized and controlled
Resident Autonomy The extent to which the resident is allowed autonomy in
the management of his/her medication
Storage The precautions taken for keeping medicines
Medication Records The amount of and the maintenance of information on
medicines in the nursing record.
Communication The extent to which communication about medicines
and residents health is going on between nurses and
physicians.
Formulary The extent to which a drug formulary is available and
promoted
Work Procedures The extent to which the process of the medication
distribution is explicitly described in written procedures
One week before the consensus meeting, all experts received an electronic copy of the
PowerPoint presentation supporting the discussion as well as the questionnaire used
during the interviews. In preparation of the meeting, a preliminary score was attributed
by 2 members of the PHEBE team (2 pharmacists who had also assisted with the
literature search, the elaboration of the questionnaire and with the interviews in the
nursing homes). Their reasoning behind this score was also provided to the panel in the
presentation. This method was used in order to initiate and facilitate possible
discussions. On each topic, the panel discussed the given scores and reasoned until a
consensus was reached. The whole scoring procedure took about 3 hours. The details
are shown in Appendix 9.
3.3.6.2 Prescribing quality scores
The procedure described above provided information on the medications used by each
individual resident and his or her relevant clinical diagnoses and care problems. With
this limited amount of information it is possible to assess to a certain extent the quality
of the process of prescribing medicines, focusing on the drug choice process of the
physicians.