Quality of prescribing in Belgian nursing homes: an electronic assessment of the medication chart

To develop a computerized assessment tool for monitoring the quality of prescribing in Belgian nursing homes. In a observational cross-sectional study of the medication charts of nursing home residents, potentially inappropriate medication (PIM) was investigated using three scoring systems for the elderly (Beers, ACOVE, BEDNURS) complemented with a list of drugdrug interactions. A representative stratified sample of Belgian nursing homes (n 76). A random sample of nursing home residents with a complete data set (n 1730) excluding palliative care patients. A combination of PIM scores to assess inappropriate, under- and overprescribing. Included residents had a mean age of 85, 78 were female. They used a mean of 7.1 chronic medications. Most PIMs were detected by the application of the ACOVE criteria for underprescribing with 58 of patients having at least one PIM. Using the BEDNURS and the Beers criteria, at least one PIM was noticed in 56 and 27 of patients, respectively. Patients characteristics showing a positive relationship with the PIM score were age, female gender, amount of clinical and nursing care problems, number of prescriptions and the use of psychotropic drugs (multiple regression analysis R-2 0.332). In Belgian nursing homes, the observed high level of drug utilization was associated with potentially inappropriate prescribing. The development of a combined assessment tool and the implementation of a computerized monitoring system of PIMs is highly recommended to improve the quality of prescribing