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Table 1 Explanation of DRP categories and evaluation criteria

From: Determine the impact of a structured pharmacist-led medication review - a controlled intervention study to optimise medication safety for residents in long-term care facilities

DRP categories Evaluation criteria
Prescribing problems
 Contraindication - Medication is generally not recommended according to the SmPCs by assessing documented diagnosis.
 Therapeutic duplication - Consideration of duplicate active drug or duplicate drug class.
 Dosing problems - Dose is not recommended (too low, too high) or not adjusted for age, weight or renal failure according to the SmPCs.
 Drug-drug interaction - Interaction described by the database used and considered as clinically relevant by using all available clinical parameters (e.g., laboratory data).
 Inappropriate administration time - Administration time is not recommended according to the SmPCs.
 Inappropriate drug form - Drug form is not appropriate for residents’ intake practices (e.g., chewing medication).
 Inappropriate treatment duration - Treatment duration is not recommended (too long, too short) according to the SmPCs.
 Inappropriate medication for indication or concomitant condition - A medication is prescribed that is not the recommended medication choice according to clinical therapy guidelines for the documented diagnosis or concomitant condition.
 Insufficient drug treatment - Additional medication is required according to clinical therapy guidelines by assessing the documented diagnosis.
 Potentially inappropriate medication - Medications with increased risk for adverse effects according to the Beers list [29]/ Priscus list (German PIM list) [30].
 Unclear indication for drug - Medication without a clear indication according to the SmPCs is used by assessing documented diagnosis.
Medication use problems
 Incorrect storage - Missing medication package according to the medication chart; Lack of recommended resident name reference on medication package; Usage of medication after expiration date.
 Incorrect dispensing - Comparison of residents medication charts with the current dispensed medication (in cups or dose administration aids prepared for administration in advance) in terms of wrong medication, wrong dose, omission, additional not prescribed medication, wrong time, not recommended division of tablets or not recommended removal from primary packaging according to the SmPCs.
 Incorrect preparation - Not recommended crushing of tablets or opening of capsules according to the SmPCs; Crushing of several tablets at the same time; Mixing of crushed and liquid medications.
 Incorrect administration - Comparison of residents medication charts with current medication administered to the residents in terms of wrong resident, wrong medication, omission, additional not prescribed medication, wrong time, no attention to individual intake problems (e.g., chewing the medication), which would require a different preparation.
Documentation problems
 Incomplete or unclear documentation in the medication records - No clear identification of the medication; No clear identification of dose or drug form when several are available; Wrong or missing information for required drug preparation or administration (e.g., crushing of tablets); Missing information for PRN medication (e.g., no minimal or maximal dose); Discrepant information (e.g., more than one medication chart available with discrepant information for medications).
  1. Abbreviations: PIM Potentially inappropriate medication, PRN pro re nata, SmPC Summary of Product Characteristics