Background and Aim
Involvement of pharmacists in the nursing home settings could provide an effective mechanism for identifying and resolving drug-related problems (DRPs) in nursing home patients, however, there are very few UK studies in this area. This paper was to describe a pilot study of pharmacist's medication review in nursing home patients.

Methods
Two Nottingham based surgeries involving 102 nursing home patients and one Primary Care Group (PCG) pharmacist were participated. The protocol was as follows:

1. A surgery-based medication review was undertaken by the pharmacist to identify DRPs.
2. Prior to meeting the GPs, the pharmacist visited the nursing homes to discuss patients' medication with nursing staff.
3. The pharmacist then met GPs face to face to discuss the recommendations.
4. Three months (Surgery A)/ 6 months (Surgery B) later, the medication records were re-reviewed by the pharmacist to identify any changes in regimen.

The number of drug items per patient before and after the intervention was compared to assess the impact of the pharmacist's medication review.

Results
Two hundred and twenty-six DRPs were identified and 93% of recommendations were accepted by the GPs. One problem or more was identified among 74.5% of the patients. About half of problems were discovered after discussion with the nursing staff and only 40% were found by the pharmacist alone. "No longer needed" (21.2%), "Lack of information" (16.8%), "Quantity of supply: too many" (10.6%) and "Generic substitution" (9.3%) were the top four problems. "Analgesics" (16.4%), "Hyponotics/Anxiolytics & antipsychotic drugs"(14.6%) and "Laxatives" (11.5%) were the top three drug items caused the DRPs. There was a mean reduction of 0.8 items per patient in surgery A (P<0.001) but no difference was identified in surgery B (P=0.268).

Discussion
The results indicated a high incidence of DRPs in nursing home patients. Types of DRPs and classes of drugs caused DRPs were very similar in different surgeries. This might be because the intervention was carried out by the same pharmacist. To discover different criteria or methods used by the different pharmacists, qualitative interviews will be held with all PCGs pharmacists. This study suggested that the communication with other medical professions is very important for pharmacists to identify and resolve DRPs. Thus, to explore GPs' and nursing staff's perspectives about working with pharmacists, interviews will be conducted in the main study. Participating pharmacists will be advised to re-visit surgeries 3 months later, as the longer the time lag is, the more new symptoms the patients may develop for which additional medicine would be needed.

Findings from the main study will be able to provide a model of good practice for pharmacists working for nursing home patients.