Developing a Geriatric Pharmaceutical Care Protocol for Nursing Homes in South West Nigeria

Elderly residents of nursing homes are at heightened risk for polypharmacy-related harm and require structured pharmaceutical care protocols to ensure safe and effective medication management. This study developed a geriatric pharmaceutical care protocol for nursing homes in Oyo and Osun States, South West Nigeria. A programme development approach combining structured assessment of current pharmaceutical care provision, systematic literature review, and expert consensus was adopted. Assessments were conducted at six nursing homes in Ibadan and Osogbo through facility surveys, medication use audits for 80 residents, and interviews with nursing home staff and visiting physicians. Medication reviews revealed polypharmacy (five or more drugs) in 67.5 percent of residents and potentially inappropriate prescribing using Beers Criteria 2023 in 44.4 percent. The protocol developed addresses seven pharmaceutical care dimensions: admission medication review, ongoing monthly medication reviews, appropriate prescribing assessment using validated tools, psychotropic medication safety monitoring, fall risk assessment integrating drug contributions, end-of-life medication deprescribing guidance, and emergency medication management. A documentation framework and pharmacist scheduling model are provided for operational implementation. Delphi consensus with 12 geriatric pharmacy and geriatric medicine experts validated all protocol components. The study recommends mandatory adoption of the protocol by all registered nursing homes in the South West zone and pharmacist-nursing home partnership arrangements facilitated by state pharmacy councils.

Keywords: geriatric pharmaceutical care, nursing homes, polypharmacy, South West Nigeria, potentially inappropriate prescribing