Prescription errors pricier for nursing homes

Jurong Polyclinic senior pharmacist Chia Hui Shan (left) discussing patients' medicine with staff nurse Dolores Anuber at St Joseph's Home.

Three in five nursing home patients could be taking medication in the wrong dosage or, sometimes, the wrong medication altogether.

Not only is this putting them at a higher risk of falls and heart problems, it could also be costing them more.

A review of patients in three nursing homes by pharmacists from the National Healthcare Group (NHG) found that the 480 patients had 392 medication issues among them.

Some had more than one issue, especially those who were taking many different medicines. Some patients were taking as many as 20 different types of medicine.

The review findings were published in an article in the September edition of the Singapore Medical Journal.

The pharmacists identified, among other things, 66 patients who were receiving wrong doses, 46 who had untreated conditions and 64 who were on medication they did not need, over a six month period.

As a result, 60 patients were at a higher risk of falls because of the medicine they were taking; 49 had constipation, largely caused by the prolonged use of antihistamines for the treatment of itch; 66 had poor cholesterol or diabetes control and 31 suffered from anaemia.

The pharmacists decided to do the review because similar studies overseas showed that, in nursing homes, having too many or inappropriate medicines raised costs, drug interactions, adverse effects and hospitalisation.

Chia Hui Shan, a senior pharmacist at Jurong Polyclinic and the lead author of the article, said the same appears to be happening here.

In the article, the pharmacists suggested: "Physicians and nurses may face some initial challenges in this new collaboration; this may especially be the case for physicians, who may feel that their prescribing practices are being unfairly questioned."

The NHG review, done in 2011, wanted to determine if nursing homes would accept pharmacists' recommendations on medication and what it would cost to involve pharmacists in such homes.

So the researchers checked if their advice was being followed, six months later.

They found that acceptance varied from 36 per cent at one nursing home to 74 per cent at another.

St Joseph's Home at Mandai Estate, one of the three nursing homes reviewed, has continued getting a pharmacist in on a weekly basis to review the medicines its more than 120 patients are taking, as the scheme has helped patients, said Sister Gillan Beins, its assistant director of nursing.

"Sometimes doctors and nurses may overlook something that the pharmacist picks up. We should work as a team with patients' welfare as priority," she said.

The review found that the homes actually saved about $77 a month, even after paying for the pharmacist. It added that savings would be higher if indirect cost savings - such as lower hospitalisation rates and better management of under or untreated conditions - were taken into account.

Sister Beins said even if it cost more, the home is willing to bear the cost as it benefits patients by cutting the side effects from unnecessary medicines.

Ms Chia said the three homes reviewed were typical and the same problems are likely to occur in all nursing homes.

As a result of the review and the positive response for nursing homes, NHG now does medicine reviews for 20 nursing homes. Singapore has about 70 nursing homes.

salma@sph.com.sg


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