Polypharmacy, the use of multiple or inappropriate medications, has the potential to harm older adults by causing cognitive impairment, falls, and hospitalisations. The nurse-led intervention (The ADRe Profile) to review mental health medicines has demonstrated improved care quality by: identifying serious adverse drug reactions (ADRs); reducing prescription of mental health medicines; reducing the prevalence of pain and nausea; and, increasing non-urgent national health service (NHS) contacts. The investigators will develop ADRe to encompass medicines commonly prescribed in primary care and evaluate intervention implementation in care homes in Aneurin Bevan University Health Board.

The investigators will introduce medicines' monitoring using the PADRe Profile into up to 7 care homes, each with up to 26 residents prescribed >4 medicines (estimated ~90% residents).

Each home will identify a nurse lead and a deputy. Nurses will be asked to administer the PADRe Profile with all patients prescribed >4 medicines.

Barriers, facilitators, and feasibility of the Profile will be explored. This will identify how, in which contexts medicines' monitoring can be integrated into routine care, relate the Profile to improved processes and outcomes of care, and inform implementation strategies (see logic model in cited papers).

Data collection:

• Record review before and after each of 3 administrations of the intervention to identify clinical and prescription changes. Narrative accounts of problems causing moderate or severe harm will be prepared.
• Serial interviews and debriefs with nurses: three per nurse.
• Stakeholder interviews with patients, participating pharmacists and prescribers for an overview of implementation.

Inclusion Criteria:

• • Resident at the care home and expected to continue to live there for 1 year

  • Currently taking >3 prescribed medicines daily
  • Willing and able to give informed, signed consent themselves, or where capacity is lacking, a consultee is willing to give advice and assent to the resident participating.

Exclusion Criteria:

• age <18

  • Prescribed <4 medicines daily;
  • Receiving active palliative care
  • Not well enough to participate, as screened by their nurses

The terms of our ethical approval would not allow this.

care home residents, aged >18, receiving >3 prescribed medicines, expecting to remain in the home for at least 1 year, able to give informed consent or with a consultee willing to do this on their behalf.

5 months (throughout the study period)

Standard definitions were used. However, adverse events were unlikely to emanate from the use of a paper-based checklist.

Use of the intervention could not be blinded.