Adverse drug reactions and current state of drug regimen review in nursing facilities: need for a change?

OBJECTIVE: To review the salient issue of adverse drug reactions in nursing facilities.

SETTING: Nursing facilities across the United States.

PRACTICE DESCRIPTION: Federally mandated, retrospective drug regimen reviews (DRRs) performed by consultant pharmacists are discussed as the impetus for change.

PRACTICE INNOVATION: A prospective process of medication therapy management that involves pharmacists interacting with the interdisciplinary care team is described as a way to deliver high-quality, medication-related health care at the point of care. The paper presents the Fleetwood model as an exemplar of the proposed care model and--as well as the recent revisions to the interpretive guidelines for the State Operations Manual (SOM)--as a means of changing the way medication therapy management is deployed in nursing facilities.

MAIN OUTCOME MEASURES: Change in nursing facility pharmacy practice.

RESULTS: In settings where the Fleetwood model has been implemented, researchers have observed numerous changes, including increased clinical involvement by dispensing and consultant pharmacists, reduced time spent on traditional DRR, increased time spent on pharmaceutical care planning, improved communication among the interdisciplinary team, and more efficient processes within the nursing facility pharmacy. Changes in the Pharmacy Services Tags (F425, F428, F431) and Unnecessary Medications Tag (F329) in the interpretive guidelines for the SOM, released by the Centers for Medicare and Medicaid Services, have significant implications for the way consultant pharmacists practice.

CONCLUSIONS: Application of prospective medication therapy management, such as that contained in the Fleetwood model, and changes to the interpretive guidelines support greater pharmacist involvement at the point of care, which has potential to dramatically decrease adverse drug reactions in nursing facilities.