International Journal of Clinical Pharmacy

, Volume 35, Issue 5, pp 668–672 | Cite as

Development of a computer system to support medication reviews in nursing homes

  • Hugo A. J. M. de WitEmail author
  • Carlota Mestres Gonzalvo
  • Kim P. G. M. Hurkens
  • Wubbo J. Mulder
  • Rob Janknegt
  • Frans R. Verhey
  • Jos M. G. A. Schols
  • Paul-Hugo M. van der Kuy


The frail elderly populations of nursing homes frequently use drugs and suffer from considerable comorbidities. Medication reviews are intended to support evidence based prescribing and optimise therapy. However, literature is still ambiguous regarding the optimal method and the effects of medication reviews. Innovative computerised systems may support the medication reviews in the future. We are developing a clinical decision support system (CDSS) that, independently of the prescribing software, continuously monitors all prescribed drugs while taking into account co-medication, laboratory-data and co-morbidities. The CDSS will be developed in five phases: (1) development of the computerised system, (2) development of the clinical rules, (3) validation of the CDSS, (4) randomised controlled trial, and (5) feasibility for implementation in different nursing homes. The clinical decision support system aims at supporting the traditional medication review.


Clinical decision support systems Decision support techniques Medication reconciliation Nursing homes Pharmacovigilance Polypharmacy 



The authors would like to thank Bjorn Winkens (Department of Methodology and Statistics, Maastricht University) for his contribution to this article.


SCREEN-study supported by a grant from ZonMw (the Netherlands Organisation for Health Research and Development, Grant number: 113101001).

Conflicts of interest



  1. 1.
    Open database [Internet]. Centraal Bureau voor de Statistiek. [Cited 13 Feb 2012]. Available from: Dutch.
  2. 2.
    Malaguarnera M, Vacante M, Frazzetto PM, Motta M. What is the frailty in elderly? value and significance of the multidimensional assessments. Arch Gerontol Geriatr. 2013;56:23–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Gallagher PF, Barry PJ, Ryan C, Hartigan I, O’Mahony D. Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers’ Criteria. Age Ageing. 2008;37:96–101.PubMedCrossRefGoogle Scholar
  4. 4.
    Cherubini A, Corsonello A, Lattanzio F. Underprescription of beneficial medicines in older people: causes, consequences and prevention. Drugs Aging. 2012;29:463–75.PubMedCrossRefGoogle Scholar
  5. 5.
    Gallagher P, Barry P, O’Mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther. 2007;32:113–21.PubMedCrossRefGoogle Scholar
  6. 6.
    Shah BM, Hajjar ER. Polypharmacy, adverse drug reactions, and geriatric syndromes. Clin Geriatr Med. 2012;28:173–86.PubMedCrossRefGoogle Scholar
  7. 7.
    Knottnerus A, Dinant GJ. Medicine based evidence, a prerequisite for evidence based medicine. BMJ. 1997;315:1109–10.PubMedCrossRefGoogle Scholar
  8. 8.
    Blenkinsopp A, Bond C, Raynor DK. Medication reviews. Br J Clin Pharmacol. 2012;74:573–80.PubMedCrossRefGoogle Scholar
  9. 9.
    Dutch Healthcare Inspectorate. Beoordelingskader medicatieveiligheidverpleeghuizen [Internet]. [cited 26 June 2013 ]. Available from: Dutch.
  10. 10.
    Drenth-van Maanen AC, van Marum RJ, Knol W, van der Linden CM, Jansen PA. Prescribing optimization method for improving prescribing in elderly patients receiving polypharmacy: results of application to case histories by general practitioners. Drugs Aging. 2009;26:687–701.PubMedCrossRefGoogle Scholar
  11. 11.
    Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther. 2011;89:845–54.PubMedCrossRefGoogle Scholar
  12. 12.
    Alldred DP, Raynor DK, Hughes C, Barber N, Chen TF, Spoor P. Interventions to optimise prescribing for older people in care homes. Cochrane Database Syst Rev. 2013;2:CD009095.PubMedGoogle Scholar
  13. 13.
    Thier SL, Yu-Isenberg KS, Leas BF, Cantrell CR, DeBussey S, Goldfarb NI, et al. In chronic disease, nationwide data show poor adherence by patients to medication and by physicians to guidelines. Manag Care. 2008;17(2):48–52,55–57.Google Scholar
  14. 14.
    Jaspers MW, Smeulers M, Vermeulen H, Peute LW. Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings. J Am Med Inform Assoc. 2011;18:327–34.PubMedCrossRefGoogle Scholar
  15. 15.
    Tawadrous D, Shariff SZ, Haynes RB, Iansavichus AV, Jain AK, Garg AX. Use of clinical decision support systems for kidney-related drug prescribing: a systematic review. Am J Kidney Dis. 2011;58:903–14.PubMedCrossRefGoogle Scholar
  16. 16.
    Fossum M, Alexander GL, Ehnfors M, Ehrenberg A. Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly. Int J Med Inform. 2011;80:607–17.PubMedCrossRefGoogle Scholar
  17. 17.
    Magnus D, Rodgers S, Avery AJ. GPs’ views on computerized drug interaction alerts: questionnaire survey. J Clin Pharm Ther. 2002;27:377–82.PubMedCrossRefGoogle Scholar
  18. 18.
    Glassman PA, Simon B, Belperio P, Lanto A. Improving recognition of drug interactions: benefits and barriers to using automated drug alerts. Med Care. 2002;40:1161–71.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Hugo A. J. M. de Wit
    • 1
    Email author
  • Carlota Mestres Gonzalvo
    • 1
  • Kim P. G. M. Hurkens
    • 2
  • Wubbo J. Mulder
    • 2
  • Rob Janknegt
    • 1
  • Frans R. Verhey
    • 3
  • Jos M. G. A. Schols
    • 4
  • Paul-Hugo M. van der Kuy
    • 1
  1. 1.Department of Clinical Pharmacy and ToxicologyOrbis Medical CentreSittard-GeleenThe Netherlands
  2. 2.Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
  3. 3.Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg/School for Mental Health and NeurosciencesMaastricht UniversityMaastrichtThe Netherlands
  4. 4.Department of General Practice and Department of Health Services Research, CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtThe Netherlands

Personalised recommendations