Inservice teaching and adverse drug reactions in a nursing home

A prospective study was carried out in two skilled nursing facilities (SNFs) to determine: the feasibility of identifying potential adverse drug reactions (ADRs) by monitoring drug order changes; the ADR rate in the elderly in SNFs; the ease of using an algorithm to assess the probability that an adverse event is drug-related; and whether a one-hour inservice lecture could alter the number of drug order changes or the number of ADRs detected. Over three months, 27 of 248 order changes (10.8 percent) were identified as possible ADRs. Fifteen of 248 (six percent) of the orders were probable or definite ADRs. The ADR rates were 9.5 percent and 14.8 percent, for the study and control SNFs, respectively (p greater than 0.05). This method of detecting ADRs depends on recognition of a clinically observable adverse event by the nurse, nurse practitioner, or physician. Therefore, the hypothesis that an inservice lecture on ADRs could increase the recognition of ADRs was tested. More drug order changes were initiated in the control facility that retained a full-time nurse practitioner, but no change in the number of drug order changes or ADR rates was seen after the inservice lecture in the study facility. This method is the first to identify, prospectively, clinically manifest ADRs and to test a method to influence their rate in nursing home elderly.