TY - JOUR T1 - Medication safety in nursing home patients JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 849 LP - 852 DO - 10.1136/bmjqs-2022-014791 VL - 31 IS - 12 AU - David W Bates AU - Jonathan Zebrowski Y1 - 2022/12/01 UR - http://qualitysafety.bmj.com/content/31/12/849.abstract N2 - Globally, societies are ageing, and elderly patients take many drugs. As such, medication safety has long been a major issue in long-term care. This group of patients has substantial comorbidity and typically takes many medications, some of which are poorly tolerated in the elderly.1 This population also frequently suffers from memory impairment, and often cannot advocate for themselves effectively. Behavioural issues are frequent, and overuse of psychoactive drugs is common. In addition, electronic health record use is not as widespread as in acute care or ambulatory settings. The net impact is that many patients suffer adverse drug events (ADEs) in long-term care, and these events can cause major morbidity lasting weeks or months, yet at the same time be harder to detect than in other populations.2 Most of the published studies in this area have come from Western countries such as the USA and UK, yet especially because care delivery systems and standards of practice vary dramatically by country, more evaluations are needed in other regions of the world.The study by Ayani and colleagues3 in this issue of BMJ Quality and Safety examining the incidence and nature of ADEs and medication errors in nursing homes in Japan is therefore a welcome and relevant addition to previous studies in long-term care. Somewhat surprisingly, falls were the most frequent symptom of ADEs, representing 40% of identified events in this study. This may be related to detection bias—all falls in nursing homes are tracked, while more subtle ADEs may be missed. However, the overall incidence of ADEs was much higher in this study at 36.4 ADEs per 100 resident-months than in two prior studies in the USA, which found rates of 1.9 and 9.8 ADEs per 100 resident-months.4 5 These results have important implications for future research in … ER -