• Kaisu H Pitkälä, Anna-Liisa Juola, Hannu Kautiainen, Helena Soini, U Harriet Finne-Soveri, J Simon Bell, and Mikko Björkman.
• Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Helsinki, Finland. Electronic address: kaisu.pitkala@helsinki.fi.
• J Am Med Dir Assoc. 2014 Dec 1;15(12):892-8.

ObjectivesThe objectives of this study were (1) to investigate the effect of nurse training on the use of potentially harmful medications; and (2) to explore the effect of nurse training on residents' health-related quality of life (HRQoL), health service utilization, and mortality.DesignA randomized controlled trial.Setting And ParticipantsIn total, 227 residents in 20 wards of assisted living facilities in Helsinki were recruited. The 20 wards were randomized into those in which (1) staff received two 4-hour training sessions on appropriate medication treatment (intervention group), and (2) staff received no additional training and continued to provide routine care (control group).InterventionTwo 4-hour interactive training sessions for nursing staff based on constructive learning theory to recognize potentially harmful medications and corresponding adverse drug events.MeasurementsUse of potentially harmful medications, HRQoL assessed using the 15 dimensional instrument of health-related quality of life, health service utilization, and mortality assessed at baseline, and 6 and 12 months.ResultsDuring the 12-month follow-up, the mean number of potentially harmful medications decreased in the intervention wards [-0.43, 95% confidence interval (CI) -0.71 to -0.15] but remained constant in the control wards (+0.11, 95% CI -0.09 to +0.31) (P = .004, adjusted for age, sex, and comorbidities). HRQoL declined more slowly in the intervention wards (-0.038 (95% CI -0.054 to -0.022) than in the control wards (-0.072 (95% CI -0.089 to -0.055) (P = .005, adjusted for age, sex, and comorbidities). Residents of the intervention wards had significantly less hospital days (1.4 days/person/year, 95% CI 1.2-1.6) than in the control wards (2.3 days/person/year; 95% CI 2.1-2.7) (relative risk 0.60, 95% CI 0.49-0.75, P < .001, adjusted for age, sex, and comorbidities).ConclusionsActivating learning methods directed at nurses in charge of comprehensive care can reduce the use of harmful medications, maintain HRQoL, and reduce hospitalization in residents of assisted living facilities.Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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