{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:24:34Z","timestamp":1789802674774,"version":"4.0.1"},"reference-count":82,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T00:00:00Z","timestamp":1609977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000724","name":"The Health Foundation","doi-asserted-by":"crossref","award":["457154"],"award-info":[{"award-number":["457154"]}],"id":[{"id":"10.13039\/501100000724","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nNurse-led monitoring of patients for signs and symptoms associated with documented \u2018undesirable effects\u2019 of medicines has potential to prevent avoidable harm, and optimise prescribing.<\/jats:p>\n<\/jats:sec>\n\nIntervention<\/jats:title>\nThe Adverse Drug Reaction Profile for polypharmacy (ADRe-p) identifies and documents putative adverse effects of medicines commonly prescribed in primary care. Nurses address some problems, before passing ADRe-p to pharmacists and prescribers for review, in conjunction with prescriptions.<\/jats:p>\n<\/jats:sec>\n\nObjectives<\/jats:title>\nWe investigated changes in: the number and nature of residents\u2019 problems as recorded on ADRe-p; prescription regimens; medicines optimisation: and healthcare costs. We explored aetiologies of problems identified and stakeholders\u2019 perspectives.<\/jats:p>\n<\/jats:sec>\n\nSetting and participants<\/jats:title>\nIn three UK care homes, 19 residents completed the study, December 2018 to May 2019. Two service users, three pharmacists, six nurses gave interviews.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nThis mixed-method process evaluation integrated data from residents\u2019 ADRe-ps and medicines charts, at the study\u2019s start and 5\u201310 weeks later.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nWe recruited three of 27 homes approached and 26 of 45 eligible residents; 19 completed ADRe-p at least twice. Clinical gains were identified for 17\/19 residents (mean number of symptoms 3 SD 1.67, range 0\u20137). Examples included management of: pain (six residents), seizures (three), dyspnoea (one), diarrhoea (laxatives reduced, two), falls (two of five able to stand). One or more medicine was de-prescribed or dose reduced for 12\/19 residents. ADRe administration and review cost ~\u00a330 in staff time. ADRe-p helped carers and nurses bring residents\u2019 problems to the attention of prescribers.<\/jats:p>\n<\/jats:sec>\n\nImplications<\/jats:title>\nADRe-p relieved unnecessary suffering. It supported carers and nurses by providing a tool to engage with pharmacists and prescribers, and was the only observable strategy for multidisciplinary team working around medicines optimisation. ADRe-p improved care by: a) regular systematic checks and problem documentation; b) information transfer from care home staff to prescribers and pharmacists; c) recording changes.<\/jats:p>\n<\/jats:sec>\n\nRegistration<\/jats:title>\nNLM Identifier NCT03955133<\/jats:ext-link>; ClinicalTrials.gov.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0244519","type":"journal-article","created":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T19:38:37Z","timestamp":1610048317000},"page":"e0244519","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Nobody ever questions\u2014Polypharmacy in care homes: A mixed methods evaluation of a multidisciplinary medicines optimisation initiative"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5691-2987","authenticated-orcid":true,"given":"Sue","family":"Jordan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley","family":"Prout","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Carter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Dicomidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Hayes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Round","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Carson-Stevens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,1,7]]},"reference":[{"key":"pone.0244519.ref001","unstructured":"WHO: Medication Without Harm\u2014Global Patient Safety Challenge on Medication Safety. 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