Organization of the medication management process in Belgian nursing homes

BACKGROUND: With the increase of the proportion of old (>80 years), frail people living in long-term care settings, concern about the quality of medication management processes in nursing homes is growing. OBJECTIVES: To characterize the organization of medication management processes in Belgian nursing homes. METHOD: This cross-sectional, observational study of a representative sample of 76 Belgian nursing homes was performed in November and December 2005. The results are based on structured interviews that were conducted with 76 facility directors and 112 head nurses, using 2 questionnaires. RESULTS: A self-reporting medication error system was set up in 69.7% of the nursing homes. Almost all nursing homes had a therapeutic drug formulary, but its use was not compulsory. Medications were mainly delivered from a community pharmacy (82.9%). The role of the pharmacist was often restricted to mere delivery of medications. Medications were not always administered by nurses, but also by care aides (67%) or nursing students (12.5%). The practice of postscription (i.e., prescribing medication after it has been dispensed by the pharmacist) was also found to be quite common (69.9%). CONCLUSION: This study provides a detailed description of the organization of medication management processes in Belgian nursing homes. Based on these results, problem areas can be identified and, consequently, targeted improvement actions can be investigated and implemented.