Process Optimization Of the Medicines' pAthway in nursing Homes (POOMAH): study protocol of a cluster randomized...

The medicines' pathway in nursing homes (NHs) is complex and challenging, resulting in processes that are prone to medication errors and lack person-centredness. There is a clear need for quality improvement initiatives, for which a systems approach - rather than isolated interventions - is considered more effective. In this context, the Process Optimization Of the Medicines' pAthway in nursing Homes (POOMAH) study was established. The study aims to evaluate the effectiveness of different formats and intensities of support provided to NHs to improve the quality of the medicines' pathway.

The intervention includes four arms, each offering a different level of support: access to toolbox, intervision meetings, external coaching and integration of a coordinating pharmacist. In total, 100 NHs participate in this study, with stratified randomization used to allocate them to the intervention arms. The primary outcome is the overall quality of the medicines' pathway, through the calculation of performance scores. The key secondary outcome is the number of (psychoactive) medications used by NHRs. Other secondary outcomes include the quality of specific processes and KAs of the medicines' pathway, represented by process-specific and activity-specific performance scores, and the number of falls and hospitalizations of NHRs. A comprehensive process evaluation will also be conducted. Both quantitative and qualitative data will be collected and analyzed using (generalised) linear mixed models and content/thematic analysis, respectively.

The POOMAH study will assess and compare the effectiveness of four support levels aimed at improving the quality of the medicines' pathway in NHs. The findings will contribute to the evidence base on quality improvement in this context and inform future strategies, including the role of pharmacists in optimizing medication management.

Not applicable. Although this study was not classified as a clinical trial by the ethics committee, it was retrospectively registered in the ISRCTN registry (ISRCTN17231220) on 07 May 2025 ( https://www.isrctn.com/ISRCTN17231220 ).