Step | Time | Initiator | Label and description |
---|---|---|---|
#1 | 10 min | ECP | Patient involvement & Exploration |
NS | Nursing home residents’ experiences and preferences will be assessed by the responsible member of the NS using a standardised questionnaire. Experiences and preferences of incapacitated nursing home residents will be assessed through a questionnaire filled out by the patient's representative. Furthermore, in preparation of step #2, the ECP will compile the patient's diagnoses, allergies and laboratory results. On clinical indication, the ECP will consult a medical specialist to verify the diagnosis. Subsequently, the ECP will send these data together with the questionnaire to the P | ||
#2 | 10 min | P | Drug Reviewing |
The P will review the medication prescribed to the patient to identify both potential underprescribing using the START criteria24 and overprescribing using the STOPP criteria,1 2 13 16 17 25 and the Beers criteria.26 An automatic prompt system incorporating the START & STOPP criteria and Beers criteria will be implemented | |||
#3 | 10 min | ECP | Multidisciplinary Meeting |
P | In a meeting, the ECP and the P will review all information gathered in step #1 and #2. Subsequently, the information will be reviewed to optimise prescribing (underprescribing/overprescribing and misprescribing). If the ECP and P cannot determine the right indication for a medication (the correct diagnosis), the appropriate medical specialist(s), for example, a cardiologist, a neurologist and a geriatric psychiatrist will be consulted | ||
#4 | 5 min | ECP | Pharmacotherapeutical Action Plan |
P | The ECP and P will register the findings of the review in step #3 in a pharmaceutical action plan27 and, accordingly, the actions that need to be taken, that is, discontinuation, initiation, dose adjustment, postponing a decision. This plan will also include tapering-off arrangements to prevent occurrence of withdrawal symptoms if appropriate28 and appointments about the monitoring of relapse symptoms and withdrawal effects | ||
#5 | 10 min | ECP | Implementation & Interim Evaluation Action Plan |
NS | The ECP and the NS will further implement the pharmaceutical action plan according to the agreed schedule. To that end, the nursing staff will be clearly informed. The NS will monitor adverse withdrawal events when discontinuing medication. The ECP will monitor relapse symptoms. Furthermore, the patient or his or her representative will be informed about the medication changes to verify possible objections and to clarify that the aim of the intervention is to improve the care to nursing home residents. In this phase, the elderly care physician will also document whether a medication had to be reinstated along with the reasons using so-called trigger lists |
ECP, elderly care physician; NS, nursing staff; P, pharmacist.