APRN-Conducted Medication Reviews for Long-Stay Nursing Home Residents

Objective: As part of the Missouri Quality Initiative (MOQI) to reduce hospitalizations for long-stay nursing home residents, this article describes reasons MOQI advanced practice registered nurses (APRNs) recommended medication order changes as part of their medication review process as well as the outcomes of their recommendations. Design: Cross-sectional descriptive study of MOQI APRN-conducted medication reviews. Setting: Long-stay nursing homes participating in the MOQI project. Participants: Seventeen MOQI APRNs recorded medication reviews for 3314 long-stay residents residing in 16 Midwestern nursing homes over a 2-year period. Intervention: APRNs conducted medication reviews and made recommendations for medication order changes to residents' medical providers. Measurements: The MOQI medication review database was used to abstract data. Results: There were 19,629 medication reviews recorded for 3314 residents during the 2-year period. Of the 19,629 reviews, 50% (n = 9841) resulted in recommended order changes of which 82% (n = 8037) of order changes occurred. More than two-thirds of recommendations were because of changes in the residents' plans of care. Other recommendations included adjusting and/or discontinuing medications that had the potential for harm. Conclusion: Resident care needs are dynamic, resulting in the need for frequent medication order changes. MOQI APRNs, because of their advanced pharmacological education and daily presence in the nursing home, are uniquely positioned to ensure residents' medications aligned with their overall goals of care while minimizing risk of harm. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.