Decreasing medication use in a nursing-home patient-care unit.

The effect of a computerized drug regimen review and expanded clinical pharmacy services on medication use in a nursing-home care unit was studied. A full-time pharmacist assigned to the 120-bed nursing-home care unit of a Veterans Affairs medical center initiated a program to reduce medication use to an average of 6.1 medications per patient. The pharmacist used a monthly, computer-generated drug regimen review report to document the number of medications per patient and recommend decreases in medication use to physicians. Initiation of a standing-order policy, whereby nurses can initiate the use of specific medications, helped to reduce the number of as-needed (p.r.n.) orders and also decreased use of these medications. Within one year, the number of p.r.n. and scheduled medications used per patient was reduced from 7.20 to 5.34. Use of routinely scheduled medications was reduced by about 30%. Based on an average cost of medications administered ($0.24/dose), we calculated a cost savings of about $27,400. By reviewing patients' drug regimens, establishing a standing-order policy, and targeting scheduled medications for discontinuation, a pharmacist reduced medication use in a nursing home.