Potentially inappropriate prescribing in nursing home residents detected with the community pharmacist specific GheOP3S-tool


Background The Ghent Older People’s Prescriptions community Pharmacy Screening (GheOP³S-)tool was recently developed to screen for potentially inappropriate prescribing (PIP). Objective We aimed (1) to determine PIP prevalence in older nursing home (NH) residents with polypharmacy using the GheOP³S-tool and (2) to identify those PIPs that are most frequently detected. Method A cross-sectional study was carried out between February and June 2014 in 10 NHs in Belgium, supplied by a community pharmacy chain. For each NH, 40 residents (≥70 years, using ≥5 chronic drugs) were included. PIP prevalence was determined using the GheOP³S-tool. Results 400 NH residents were included [mean age (±SD) 86.2 (±6.3) years; median number of drugs (±IQR) 10 (7–12)]. A total of 1728 PIPs were detected in 387 (97 %) participants (Median 4; IQR 2–6). The most prevalent items can be assigned to three categories: long-term use of central nervous system drugs (i.e. benzodiazepines, antidepressants and antipsychotics), use of anticholinergic drugs (mutual combinations and with underlying constipation/dementia) and underuse of osteoporosis prophylaxis. Conclusion Screening for PIP by means of the GheOP³S-tool revealed a high prevalence of PIP among older NH residents with polypharmacy. This finding urges for initiatives on the patient-level, but also on a broader, institutional level.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Loganathan M, Singh S, Franklin BD, Bottle A, Majeed A. Interventions to optimise prescribing in care homes: systematic review. Age Ageing. 2011;40(2):150–62.

    Article  PubMed  Google Scholar 

  2. 2.

    Haasum Y, Fastbom J, Johnell K. Institutionalization as a risk factor for inappropriate drug use in the elderly: a Swedish nationwide register-based study. Ann Pharmacother. 2012;46(3):339–46.

    Article  PubMed  Google Scholar 

  3. 3.

    O’Sullivan DP, O’Mahony D, Parsons C, Hughes C, Murphy K, Patterson S, et al. A prevalence study of potentially inappropriate prescribing in Irish long-term care residents. Drugs Aging. 2013;30(1):39–49.

    Article  PubMed  Google Scholar 

  4. 4.

    Perri M 3rd, Menon AM, Deshpande AD, Shinde SB, Jiang R, Cooper JW, et al. Adverse outcomes associated with inappropriate drug use in nursing homes. Ann Pharmacother. 2005;39(3):405–11.

    Article  PubMed  Google Scholar 

  5. 5.

    Verrue C, Mehuys E, Boussery K, Adriaens E, Remon JP, Petrovic M. A pharmacist-conducted medication review in nursing home residents: impact on the appropriateness of prescribing. Acta Clin Belg. 2012;67(6):423–9.

    CAS  PubMed  Google Scholar 

  6. 6.

    Verrue CL, Petrovic M, Mehuys E, Remon JP, Vander Stichele R. Pharmacists’ interventions for optimization of medication use in nursing homes: a systematic review. Drugs Aging. 2009;26(1):37–49.

    Article  PubMed  Google Scholar 

  7. 7.

    Wallerstedt SM, Kindblom JM, Nylen K, Samuelsson O, Strandell A. Medication reviews for nursing home residents to reduce mortality and hospitalization: systematic review and meta-analysis. Br J Clin Pharmacol. 2014;78(3):488–97.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Mestres C, Agusti A, Puerta L, Barba M. Prescription of potentially inappropriate drugs for geriatric patients in long-term care: improvement through pharmacist’s intervention. Eur J Hosp Pharm Sci Pract. 2015;22(4):198–201.

    Article  Google Scholar 

  9. 9.

    Tommelein E, Petrovic M, Somers A, Mehuys E, van der Cammen T, Boussery K. Older patients’ prescriptions screening in the community pharmacy: development of the Ghent Older People’s Prescriptions community Pharmacy Screening (GheOP(3)S) tool. J Public Health. 2016;38(2):e158–70. doi:10.1093/pubmed/fdv090.

    Article  Google Scholar 

  10. 10.

    Tommelein EM, Van Tongelen I, Petrovic M, Somers A, Colin P, Demarche S, Van Hees T, Christiaens T, Boussery K. Community pharmacists’ evaluation of potentially inappropriate prescribing in older community-dwelling patients with polypharmacy: observational research based on the GheOP3S-tool. (2016, submitted).

  11. 11.

    Belgian Center for Pharmacotherapeutic Information B. Commented drug repertory 2016 [cited 2016 March 25]. http://www.bcfi.be/.

  12. 12.

    WHO Collaborating Centre for Drug Statistics Methodology—Norwegian Institute of Public Health. ATC/DDD Index 2016 [cited 2016 March 26]. http://www.whocc.no/atc_ddd_index/.

  13. 13.

    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ (Clin Res ed). 2007;335(7624):806–8.

    Article  Google Scholar 

  14. 14.

    Elseviers MM, Vander Stichele RR, Van Bortel L. Quality of prescribing in Belgian nursing homes: an electronic assessment of the medication chart. Int J Qual Health Care. 2014;26(1):93–9.

    Article  PubMed  Google Scholar 

  15. 15.

    Bergman Å, Olsson J, Carlsten A, Waern M, Fastbom J. Evaluation of the quality of drug therapy among elderly patients in nursing homes: a computerized pharmacy register analysis. Scand J Prim Health Care. 2007;25(1):9–14.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Shah SM, Carey IM, Harris T, DeWilde S, Cook DG. Quality of prescribing in care homes and the community in England and Wales. Br J Gen Pract. 2012;62(598):e329–36.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Kolzsch M, Kopke K, Fischer T, Hofmann W, Kuhnert R, Bolbrinker J, et al. Prescribing of inappropriate medication in nursing home residents in Germany according to a French consensus list: a cross-sectional cohort study. Pharmacoepidemiol Drug Saf. 2011;20(1):12–9.

    Article  PubMed  Google Scholar 

  18. 18.

    Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol. 2015;71(12):1415–27.

    Article  PubMed  Google Scholar 

  19. 19.

    Ryan C, O’Mahony D, Kennedy J, Weedle P, Cottrell E, Heffernan M, et al. Potentially inappropriate prescribing in older residents in Irish nursing homes. Age Ageing. 2013;42(1):116–20.

    Article  PubMed  Google Scholar 

  20. 20.

    Bourgeois J, Elseviers MM, Van Bortel L, Petrovic M, Vander Stichele RH. Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study. Eur J Clin Pharmacol. 2014;70(10):1251–60.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Kersten H, Molden E, Tolo IK, Skovlund E, Engedal K, Wyller TB. Cognitive effects of reducing anticholinergic drug burden in a frail elderly population: a randomized controlled trial. J Gerontol Ser A Biol Sci Med Sci. 2013;68(3):271–8.

    CAS  Article  Google Scholar 

  22. 22.

    World Health Organization Collaborating Centre for Metabolic Bone Diseases. Fracture risk assessment tool United Kingdom: University of Sheffield [cited 2016 March 25]. https://www.shef.ac.uk/FRAX/tool.jsp.

Download references


We would like to thank the community pharmacy chain for providing us with the dataset and assistance when case clarification was needed.


No financial remuneration was received for the study.

Author information



Corresponding author

Correspondence to Eline Tommelein.

Ethics declarations

Conflicts of interest

All authors completed the ICMJE-form. No competing interests were declared.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 21 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tommelein, E., Mehuys, E., Petrovic, M. et al. Potentially inappropriate prescribing in nursing home residents detected with the community pharmacist specific GheOP3S-tool. Int J Clin Pharm 38, 1063–1068 (2016). https://doi.org/10.1007/s11096-016-0366-6

Download citation


  • Aged
  • Belgium
  • GheOP³S
  • Inappropriate prescribing
  • Nursing homes
  • PIP