178Nursing Home Prescribing Practices: An Observational Study of a Single Centre Managed by a Geriatrician

Abstract

Background: Polypharmacy is common in Nursing Home (NH) patients, with up to 50% of NH patients taking.9 medications. There are also high prescribing rates of potentially inappropriate medications (PIMs), including benzodiazepines, proton pump inhibitors (PPIs), NSAIDs and aspirin. It is important to note, however, that a large degree of inter-centre variability has been demonstrated in relation to prescribing in NH patients. We set out to describe prescribing practices in a single NH centre, primarily managed by a geriatrician. Method: Pharmacy prescriptions were reviewed for all NH patients aged ≥65 in a single centre. These were cross referenced against medication administration records. Data was collected on all oral and transdermal medications prescribed regularly, in addition to as required medications that had been administered in preceding month. Results: 43 patients were included. The average age was 82.6 (SD = 9), and 65% (n = 28) were female. 29.5% of patients (n = 13) were taking ≥9 medications. The average prescription per patient was 7.4 (SD = 2.8). All patients were taking at least one medication. The 8 most commonly prescribed medication groups included laxatives (84%), paracetamol (53%), PPIs (49%), antidepressants (47%), antiepileptics (42%), antihypertensives (40%), calcium/vitamin D supplements (40%) and antithrombotics (35%). In relation to other medications of note, 23% were prescribed atypical antipsychotics, 21% prescribed hypnotics, 14% prescribed benzodiazepines and 9% prescribed NSAIDs. 30% of patients were taking strong opioid analgesics, all of whom were coprescribed laxatives. No patients were prescribed diuretics, typical antipsychotics or dual antithrombotics. One patient was taking both aspirin and a NSAID. Conclusion: Specialist geriatric management, in addition to frequent interdisciplinary pharmacy meetings, may have impacted prescribing practices in this centre. The antipsychotic and PPI prescription rate had decreased since previous review, however, prescription rates of benzodiazepines was unchanged, with hypnotics increased. Further work is needed to optimise medication management in this centre.