Polypharmacy poses risks for residents in nursing homes. The pilot program «progress! Medication safety in nursing homes» shows how medication safety can be improved in long-term care.
Need for action
86% of the residents in nursing homes take several medications daily and are thus affected by polypharmacy. This poses great dangers. The risk of adverse drug events (ADEs) increases with each additional medication taken.
Polypharmacy is particularly problematic when it is based on potentially inappropriate prescribing (PIP) and/or potentially inappropriate medication (PIM). This refers to situations in which medication is inconsistent with diagnoses or is inappropriately chosen for the older person. Such prescriptions carry increased risks for preventable ADEs. 79% of residents in Swiss nursing homes receive at least one PIM.
The program aims to reduce adverse drug events (ADEs) in Swiss nursing homes. It consists of a baseline project (2016-2018) and an in-depth project (2019-2021).
The baseline project served to inventory and analyze medication processes in Swiss nursing homes and to identify primary areas for action. The scientific evidence for the data report was provided by surveys of nursing home managers and home and family physicians. In addition, the international literature (review reports from 2015 and 2019) and similar research projects were analyzed, and continuous exchange with experts was maintained. The executive summary of the final report outlines the most important findings.
Based on the findings from the basic project, quality standards for safer and resident-oriented medication in nursing homes were defined. The implementation should be supported by further measures and materials. In 2020, the feasibility and effectiveness of the recommended quality standards including measures and materials should be tested in five nursing homes each in the cantons of Zurich and Valais. However, due to the Covid 19 pandemic, the piloting could not be realized. The in-depth program was therefore be completed by the end of June 2021. The quality standards as well as all materials developed but not tested are available on the Foundation's website free of charge and in all three national languages. Without piloting, however, no statements can be made about the feasibility or effectiveness of the materials. The Executive Summary of the final report (in german) summarizes the key findings.
Quality standards (QS)
To achieve the program goal, quality standards were developed in a consensus process. These standards describe the minimum requirements for the medication process and for the cooperation of the specialists.
- QS I: Medication is checked regularly and in defined situations.
- QS II: The medication review is carried out in a structured manner.
- QS III: The medication is monitored in a structured manner.
- QS IV: All professionals are committed to optimal interprofessional collaboration.
- QS V: Residents are actively involved in the medication process.
The following documents describe the QS in more detail
- QS Short version (PDF, June 2021)
- QS Long version (PDF, June 2021)
Materials for QS implementation
To implement the quality standards, various materials were developed in collaboration with scientific cooperation partners. These are based on the fields of action identified in the basic project.
- Promotion of professional knowledge and sensitization
- Promotion of interprofessional cooperation between physicians, nursing staff and pharmacists
- Promotion of tools to implement the quality standards
Three e-learning modules are available for training for all professional groups involved in the medication process in nursing and care homes. The focus is on the topics of polypharmacy and potentially inadequate prescriptions and medication, as well as on information for the implementation of the quality standards for the respective professional group. The modules for physicians and pharmacists are accredited by the following professional societies: FPH (12.5 points), SGAIM (1 credit), SGKPT (2 credits).
An e-learning module on “interprofessional collaboration” complements the profession-specific e-learnings and can also be completed separately. By means of interactive case studies, optimal collaboration within the treatment team is illustrated. The conception and development of the content on interprofessionality was awarded the IP-Health-Price for interprofessional collaboration in 2020.
Here you can request access to the e-learning modules:
- E-Learning module nursing and nursing assistants
- E-Learning module physicians and pharmacists
- E-Learning module interprofessional collaboration
Observation tools for nursing (from June 2021)
Nursing professionals and assistants have an important role in the quality standards in observing residents. The following two tools are intended to support nursing staff in meeting the aforementioned minimum requirements. Instructions on how to use them have been developed for this purpose.
- The ADR tool is an overview map that lists the most frequent adverse drug reactions (ADRs) of the most commonly prescribed drugs and PIMs in Swiss nursing homes. It is used to monitor and identify ADRs.
- The Stop&Watch tool is a documentation and communication tool that enables nursing home staff in particular to observe, document and communicate non-specific changes in residents.
Guidance and recommendation form for the pharmaceutical examination (from June 2021 on)
The instructions support pharmacists in conducting a pharmaceutical examination according to quality standards and setting out recommendations in writing. These can be documented in a standardized manner by means of a recommendation form and forwarded to the physician.
Downloads (mainly in German)
- A survey on what pharmacists and physicians caring for nursing home residents expect of user-friendly lists of potentially inappropriate prescribing (PIP lists), Lüscher S, ZEFQ, 8/2020
Financial and ideological support
The basic project was financially supported by the FOPH, the LOA IV/1 research fund and the Hanela Foundation. The in-depth project was financed by the FOPH. The professional societies and associations listed with the logo provided non-material support for the in-depth program.
Scientific cooperation partners
- Kerstin Bilinski, Pflegecontrolling, Alterswohnsitz Bürgerspital St. Gallen (bis 12/2018)
- Mélanie Bruhlhart, Apothekerin, Pharmacie interjurassienne, Moutier
- Prof. Olivier Bugnon, Pharmacien chef Policlinique Médicale, CHUV (bis 05/2020)
- Sabine Felber, Leiterin Pflege und Betreuung, Betagtenzentrum Emmen AG
- Dr. med. Dan Georgescu, Chefarzt Bereich Alters- und Neuropsychiatrie, PDAG
- Dr. med. Max Giger, Unabhängige Beschwerdestelle für das Alter, ZH/SH
- Dr. med. Rolf Goldbach, Geriatrischer Dienst der Stadt Zürich
- Saadet Grandazzo, Stv. Leiterin Betreuung und Pflege, Suhrental Alterszentrum AG
- Monika Kahindi-Knecht, Fachfrau Langzeitpflege, Viva Luzern AG Rosenberg (bis 12/2018)
- Michael Kirschner, Wiss. Mitarbeiter, Fachbereich Menschen im Alter, Curaviva
- Christian Streit, Geschäftsführer senesuisse
- Prof. Dr. med. Andreas Stuck, Klinikdirektor Geriatrische Universitätsklinik, Inselspital (bis 12/2018)
- Dr. med. Florian Suter, Geschäftsführer Ärztenetz Nordwest AG
- Carole Pelletier, Pflegefachfrau MAS in Gerontologie, ehemalige Heimleiterin
- Carlo Vassella, Apotheker, Monte Carasso
- Dr. Franziska Zúñiga, Institut für Pflegewissenschaft, Universität Basel