MEDICATION PRESCRIBING AND ADMINISTRATION IN NURSING-HOMES

Objective: to examine the key determinants of pharmaco-epidemiology in Australian nursing homes. Design: a cross-sectional survey of medicat ion use in 998 residents in 15 nursing homes in Southern Queensland an d Northern New South Wales, Results: the total, laxative, digoxin/diur etic, benzodiazepine and psycholeptic medication prescribed and admini stered to residents of nursing homes was affected to differing extents by age and gender, the nursing home, resident functional disability a nd medical practitioner. Resident Classification Instrument (RCI) cate gory and nursing home were the dominant determinants for prescribing a nd administration of the total drugs, laxative, benzodiazepine and psy choleptic medications. In contrast, the resident use of digoxin and/or diuretics was dependent on the resident age and on the functional dis ability (RCI category) of the resident but not medical practitioner or nursing home. Approximately 30% of medications were prescribed on a p ro re nata (p.r.n.) basis and administered at the discretion of regist ered nurses. Conclusion: nursing home culture is a major determinant o f the variability in medication use between residents, particularly fo r those medications often prescribed for p.r.n. use. The nursing home does not account for variation in the use of digoxin and/or diuretics which are prescribed on a non-discretionary basis.