The full content of Annals is available to subscribers

Subscribe/Learn More  >
Medicine and Public Policy |

Inappropriate Medication Prescribing in Skilled-Nursing Facilities

Mark H. Beers, MD; Joseph G. Ouslander, MD; Susan F. Fingold, BS; Hal Morgenstern, PhD; David B. Reuben, MD; William Rogers, PhD; Mira J. Zeffren, PharmD; and John C. Beck, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by the John A. Hartford Foundation and by the University of California, Los Angeles, Geriatric Academic Program Award from the National Institutes of Health (Dr. Beers).

Requests for Reprints: Mark H. Beers, MD, Merck & Co., Inc., BLA-22, POB4, West Point, PA 19486-0004.

Current Author Addresses: Dr. Beers: Merck & Co., Inc., BLA-22, POB4, West Point, PA 19486-0004.

Drs. Ouslander, Reuben, and Beck, and Ms. Fingold: University of California, Los Angeles, Multicampus Division of Geriatrics and Gerontology, Center for Health Sciences, School of Medicine, Factor A-671, Los Angeles, CA 90024-1687.

Dr. Morgenstern: University of California, Los Angeles, School of Public Health, Department of Epidemiology, Los Angeles, CA 90024-1772.

Dr. Rogers: The Rand Corporation, 1800 Main Street, Santa Monica, CA 90403.

Dr. Zeffren: Patient Care Pharmacy, 6300 Arizona Circle, Los Angeles, CA 90045.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;117(8):684-689. doi:10.7326/0003-4819-117-8-684
Text Size: A A A

Objective: To quantify the appropriateness of medication prescriptions in nursing home residents.

Design: Prospective, cohort study.

▪ Setting: Twelve nursing homes in the greater Los Angeles area.

Participants: A total of 1106 nursing home residents.

Main Outcome Measures: The appropriateness of medication prescriptions was evaluated using explicit criteria developed through consensus by 13 experts from the United States and Canada. These experts identified 19 drugs that should generally be avoided and 11 doses, frequencies, or durations of use of specific drugs that generally should not be exceeded.

Results: Based on the consensus criteria, 40% of residents received at least one inappropriate medication order, and 10% received two or more inappropriate medication orders concurrently; 7% of all prescriptions were inappropriate. Physicians prescribed a greater number of inappropriate medications for female residents. Regression analysis, corrected for clustering effects within facilities, showed that a greater number of inappropriate medication prescriptions were ordered in larger nursing homes. Inappropriate prescriptions were not related to the proportion of Medicaid (Medical) residents or the number of physicians practicing in the homes.

Conclusions: Inappropriate medication prescribing in nursing homes is common. Female residents and residents of large nursing homes are at the greatest risk for receiving an inappropriate prescription.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Journal Club
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.