Using Health Information Technology to Reduce Adverse Drug Events in Long-Term Care Facilities

Polypharmacy is common in nursing homes, with an estimated 40% of residents taking nine or more medications daily. Use of multiple medications may be a leading contributor to adverse drug events (ADEs), such as delirium and falls. Health information technology (HIT) is increasingly being employed to monitor and lower the risk of ADEs in a variety of care settings; however, while HIT typically focuses on preventing medication errors at the point of prescribing, dispensing, or administration, an approach that focuses on the monitoring stage of medication use may be more effective in long-term care (LTC) settings, according to a noteworthy new study (www.ncbi.nlm.nih.gov/pubmed/21649623) published in the June issue of the Journal of the American Geriatrics Society.

The 4-year study, led by Kate L. Lapane, PhD, Virginia Commonwealth University, evaluated the efficacy of the American Society of Consultant Pharmacists’ Geriatric Risk Assessment MedGuide (GRAM) health informatics software in reducing the risk of delirium, falls, associated hospitalizations, and death among residents at 25 LTC facilities. Twelve facilities, which cumulatively housed approximately 1500 residents, were randomly selected to serve as controls. The remaining 13 facilities housed approximately 1700 residents and began using GRAM, which is designed to improve drug treatment by automatically generating and implementing medication monitoring care plans for patients at high risk of 15 ADEs, including delirium and falls.

Over the course of the study, the GRAM program automatically generated and implemented medication monitoring plans for falls and delirium for approximately 500 residents. Among newly admitted residents, those in the GRAM group were 58% less likely to develop delirium, 11% less likely to be hospitalized, and 12% less likely to die during the study period than those in the control group. The overall incidence of falls, delirium, and mortality among all LTC residents (new admissions and longer-stay residents) were also lower in the intervention homes than in the control facilities, but the difference did not reach statistical significance. For reasons that were not clear, the incidence of hospitalization was higher in the intervention group.

The overall results of this study are important and encouraging, especially the finding regarding newly admitted LTC residents, as it has been found that these residents are at greatest risk of delirium and other serious ADEs during their first 30 days in a facility. Though the use of HIT is increasingly common, it is still less widely used in LTC facilities than in other care settings. Additional research examining how to most effectively use HIT in nursing homes and assisted living facilities is clearly warranted.