Programme no. 328-OP
Quality Improvement
The Norwegian General Practice Nursing Home criteria (NORGEP-NH) for potentially inappropriate medication use. A web based Delphi study.
Gunhild Nyborg*1, Jørund Straand2, Atle Klovning3, Mette Brekke4
1Dept. of General Practice/Family Medicine,University of Oslo,Oslo,Norway, 2Dept. of General Practice/Family Medicine,University of Oslo,Oslo,Norway, 3Dept. of General Practice/Family Medicine,University of Oslo,Oslo,Norway, 4Dept. of General Practice/Family Medicine,University of Oslo,Oslo,Norway
* = Presenting author
Objectives: To develop a set of explicit criteria for pharmacologically inappropriate medication use in nursing homes.
Background: Residents of nursing homes are often very frail, often with multiple comorbidities and some degree of organ dysfunction. Medication use in this population thus needs to be carefully balanced between the need for treatment and the increased risk of negative side-effects and interactions from drugs.
Results: Degree of consensus increased with each round. No criterion was voted out. Suggestions from the panel led to the inclusion of seven additional criteria in round two.
Material/Methods: In an expert panel, a three-round modified Delphi consensus process was conducted in Norway via online survey software. Altogether 80 specialists in geriatrics or clinical pharmacology, doctors in nursing homes, and five experienced pharmacists, agreed to participate in the survey. Of these, 65 completed the first round, and 49 panelists completed all three rounds (75.4% of those entering the survey). The authors developed a list of 27 criteria based on the Norwegian General Practice (NORGEP) criteria, literature and clinical experience. Main outcome measure was the panelists’ evaluation of the clinical relevance of each suggested criterion on a digital Likert scale from 1 (no clinical relevance) to 10. In the first round panelists could also suggest new criteria to be included into the process.
Conclusion: A validated list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed through a three-round Web-based Delphi consensus process.
Points for discussion:

1. The need for increased knowledge concerning medication use in the very old and frail and its consequences

2. The use of explicit criteria as tools for assessing inappropriate medication use in clinical practice

3. The Delphi technique as a means of acquiring consensus in panel surveys.