Effect of a pharmacist-led multicomponent intervention focussing on the medication monitoring phase to prevent potential adverse drug events in nursing homes

OBJECTIVES: To determine the extent to which the use of a clinical informatics tool that implements prospective monitoring plans reduces the incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality.

DESIGN: Randomized cluster trial.

SETTING: Twenty-five nursing homes serviced by two long-term care pharmacies.

PARTICIPANTS: Residents living in nursing homes during 2003 (1,711 in 12 intervention; 1,491 in 13 usual care) and 2004 (1,769 in 12 intervention; 1,552 in 13 usual care).

INTERVENTION: The pharmacy automatically generated Geriatric Risk Assessment MedGuide (GRAM) reports and automated monitoring plans for falls and delirium within 24 hours of admission or as part of the normal time frame of federally mandated drug regimen review.

MEASUREMENTS: Incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality.

RESULTS: GRAM triggered monitoring plans for 491 residents. Newly admitted residents in the intervention homes experienced a lower rate of potential delirium onset than those in usual care homes (adjusted hazard ratio (HR)=0.42, 95% confidence interval (CI)=0.35–0.52), overall hospitalization (adjusted HR=0.89, 95% CI=0.72–1.09), and mortality (adjusted HR=0.88, 95% CI=0.66–1.16). In longer stay residents, the effects of the intervention were attenuated, and all estimates included unity.

CONCLUSION: Using health information technology in long-term care pharmacies to identify residents who might benefit from the implementation of prospective medication monitoring care plans when complex medication regimens carry potential risks for falls and delirium may reduce adverse effects associated with appropriate medication use.

Regulatory History Material as an Extrinsic Aid to Interpretation: An Empirical Study on the Use of RIAS by the Federal Court of Canada

Since 1986, the Canadian Public Administration is required to analyze the socio-economic impact of new regulatory requirements or regulatory changes. To report on its analysis, a Regulatory Impact Analysis Statement (RIAS) is produced and published in the Canada Gazette with the proposed regulation to which it pertains for notice to, and comments by, interested parties. After the allocated time for comments has elapsed, the regulation is adopted with a final version of the RIAS. Both documents are again published in the Canada Gazette. As a result, the RIAS acquires the status of an official public document of the Government of Canada and its content can be argued in courts as an extrinsic aid to the interpretation of a regulation. In this paper, an analysis of empirical findings on the uses of this interpretative tool by the Federal Court of Canada is made. A sample of decisions classified as unorthodox show that judges are making determinations on the basis of two distinct sets of arguments built from the information found in a RIAS and which the author calls “technocratic” and “democratic”. The author argues that these uses raise the general question of “What makes law possible in our contemporary legal systems”? for they underline enduring legal problems pertaining to the knowledge and the acceptance of the law by the governed. She concludes that this new interpretive trend of making technocratic and democratic uses of a RIAS in case law should be monitored closely as it may signal a greater change than foreseen, and perhaps an unwanted one, regarding the relationship between the government and the judiciary.

Depression and Cognitive Decline: Factors Related to Demographics and Psycho Pharmacotherapy on Elderly in Nursing Homes

Objectives: To identify the prevalence of neuropsychiatric disorders, especially DP and CD, on a sample of nursing home residents, relating this prevalence with some aspects of the demographics and psycho pharmacotherapy. Methods: 48 elders from two different nursing homes were selected. The collection of demographic and pharmacological data was made utilizing medical records. The medication was classified according to the Anatomical Therapeutic Chemical Code (ATC) criteria. The Geriatric Depression Scale (GDS 30) and the Mini Mental State Examination (MMSE) tests were utilized to determine the prevalence of DP and CD. Results: It was observed in the sample a high incidence of DP and CD among the researched elders. More schooling individuals tend to present less CD. Individuals with less CD indicatives present less symptomatology for DP. Of all the researched elders, 54,2% are submitted to psycho pharmacotherapy. Of all the consumed medicine, 16,5% belonged to the class of neuropsychiatric medicine. The medicated elders present, in average, a larger symptomatology for DP (12 points/average/GDS) than the non-medicated elders (9,9 points/average/GDS). The inverse occurs in relation to the CD indicatives. The use of psychotropics, especially in association, can have negative effects related to depression and cognition. Discussion: The pharmacotherapy, characterized for the polymedication and chronicity, especially of neuropsychiatric medicines, deserves special attention among elders, because the data suggest a significant relation between the utilization of medicines, singly or in association, and the increase of CD and DP. In addition, the data suggest that DP is a risk factor for CD and DM.

Nursing Homes as a Setting for Psychological Practice: Public Policy Perspectives.

Recent federal legislation has provided renewed interest in improving the quality of nursing home care. The lack of both funding and personnel are significant barriers that may keep psychology's disciplinary expertise from being fully used in nursing homes. Nursing homes may be forced to undertake mandated activities (e.g., preadmission screening, nurses aides' training, and evaluation) without psychologists' expertise, relying either on medical practitioners with little knowledge of mental health interventions or on minimally qualified, entry-level mental health workers. Advocates for improved nursing home care must see the links among basic disciplinary skills, interdisciplinary collaboration, and improved care for mentally impaired elderly individuals.

Defense highway act of 1941. Hearing before the Committee on Post Offices and Post Roads, United States Senate, Seventy-seventh Congress, first session, on S. 1580, a bill to supplement the Federal aid road act, approved July 11, 1916, as amended and supplemented, to authorize appropriations during the National emergency declared by the President on May 27, 1941, for the immediate construction of roads urgently needed for the National defense, and for other purposes, June 4, 1941 ...

Kenneth McKellar, chairman.

Review of apportionments of Federal-aid highway funds, Bureau of Public Roads, Department of Commerce, for fiscal years 1956-1963, report to the Congress of the United States

Mode of access: Internet.

[Documents bearing on the suit brought by the Commonwealth of Massachusetts in the Supreme Court of the U.S. to test the constitutionality of the Sheppard-Towner Act involving the principle of federal aid legislation.]

Mode of access: Internet.

Federal-aid highway act of 1948. Hearings before the Subcommittee on Roads of the Committee on Public Works, House of Representatives, Eightieth Congress, second session, on H.R. 5888 (H.R. 4867 and H.R. 4868) bills to amend and supplement the Federal aid road act approved July 11, 1916 (39 Stat. 355), as amended and supplemented, to authorize appropriations for continuing the postwar construction of highways, and for other purposes. January 29, 30, February 5, 6, 16, 17, and18, 1948.

"No. 16."

Federal aid primary route 340 interstate route 55 to interstate route 80 Cook, DuPage, and Will Counties : final environmental impact statement and section 4(f) evaluation : submitted pursuant to 42 U.S.C. 4332(2)(c) and 49 U.S.C. 303 /

"FHWA-IL-EIS-93-03-D/4(F)"

Federal aid primary route 310 (U.S. Route 67) from Illinois route 104 northwest of Jacksonville south to U.S. Route 36 Morgan County, Illinois : environmental assessment /

"FHWA-IL-EA- 03 - 93."

Federal aid primary route 406 (Supplemental freeway FAP 406), Lincoln to Morton, Illinois, Logan and Tazewell Counties : final environmental impact statement /

"FHWA-IL-EIS-83-01-F."

Illinois nursing homes : a report to the Illinois General Assembly /

"This report is respectfully submitted pursuant to House Resolution 115 adopted by the Illinois House of Representatives on April 22, 1975."

Lake County nursing homes : a report to the Illinois General Assembly /

Mode of access: Internet.