Table II.
Norwegian General Practice Nursing Home (NORGEP-NH) criteria for potentially inappropriate medication use in nursing home residents.1 Mean scores with standard deviations and final score.
| Criterion: | Round 1 MS (SD) | Round 2 MS (SD) | Round 3 MS (SD) | Final score2 |
|---|---|---|---|---|
| A: Single substance criteria. The following should be avoided for regular use whenever possible: | ||||
| 1. Combination analgesic with codeine/paracetamol | 6.5 (2.3) | 8.3 (1.8) | 8.5 (1.4) | 7.1 |
| 2. Tricyclic antidepressants (TCAs) for depression | 7.2 (2.1) | 9.1 (1.2) | 9.5 (0.7) | 8.8 |
| 3. NSAIDs | 8.8 (2.0) | 9.8 (0.6) | 9.8 (0.5) | 9.3 |
| 4. First-generation antihistamines | 7.6 (2.4) | 8.6 (1.6) | 9.3 (1.0) | 8.3 |
| 5. Diazepam | 9.1 (1.7) | 9.6 (1.0) | 9.7 (1.0) | 8.7 |
| 6. Oxazepam: Dosage > 30 mg/day | 8.8 (1.5) | 9.4 (1.2) | 9.6 (1.0) | 8.6 |
| 7. Zopiklone: Dosage > 5 mg/day | 7.6 (2.4) | 8.1 (2.0) | 8.5 (1.8) | 6.7 |
| 8. Nitrazepam | 8.7 (1.9) | 9.5 (1.0) | 9.7 (0.8) | 9.1 |
| 9. Flunitrazepam | 9.3 (1.5) | 9.8 (0.6) | 9.9 (0.2) | 9.7 |
| 10. Chlometiazole | 8.6 (1.9) | 9.1 (1.2) | 9.2 (1.3) | 7.9 |
| 11. Regular use of hypnotics | N/A3 | 8.5 (2.0) | 9.2 (1.3) | 7.9 |
| B: Combination criteria. The following drug combinations should be avoided whenever possible: | ||||
| 12. Warfarin + NSAIDs | 9.6 (1.1) | 10.0 (0.1) | 10.0 (0.3) | 9.7 |
| 13. Warfarin + SSRI/SNRI | 7.3 (2.5) | 7.8 (1.5) | 8.1 (1.4) | 6.7 |
| 14. Warfarin + ciprofloxacin/ofloxacin/ erythromycin/ clarithromycin | 8.1 (2.4) | 9.1 (1.3) | 9.2 (1.1) | 8.1 |
| 15. NSAIDs/coxibs + ACE-inhibitors/AT2-antagonists | 9.1 (1.3) | 9.4 (1.1) | 9.6 (1.0) | 8.6 |
| 16. NSAIDs/coxibs + diuretics | 8.0 (2.2) | 8.6 (1.8) | 9.2 (1.6) | 7.6 |
| 17. NSAIDs/coxibs + glucocorticoids | 8.2 (2.1) | 9.2 (1.3) | 9.5 (0.9) | 8.6 |
| 18. NSAIDs/coxibs + SSRI/SNRIs | 7.2 (2.5) | 8.1 (1.9) | 8.8 (1.5) | 7.3 |
| 19. ACE-inhibitors/AT2-antagonists + potassium or potassium-sparing diuretics | 8.4 (2.0) | 9.2 (1.3) | 9.6 (0.8) | 8.8 |
| 20. Beta blocking agents + cardioselective calcium antagonists | 8.5 (2.0) | 9.3 (1.2) | 9.6 (0.8) | 8.8 |
| 21. Erythromycin/clarithromycin + statins | 8.3 (2.0) | 9.5 (0.9) | 9.6 (0.8) | 8.8 |
| 22. Bisphosphonate + proton pump inhibitors | 6.6 (2.4) | 6.8 (2.1) | 7.4 (1.8) | 5.6 |
| 23. Concomitant use of three or more psychotropic drugs | 9.6 (0.7) | 9.9 (0.5) | 10.0 (0.1) | 9.9 |
| 24. Tramadol + SSRIs | N/A2 | 8.5 (1.8) | 9.2 (0.9) | 8.3 |
| 25. Metoprolol + paroxetine/fluoxetine/bupropion | N/A2 | 8.9 (1.1) | 9.1 (1.0) | 8.1 |
| 26. Metformin + ACE-inhibitors/AT2-antagonists + diuretics | N/A2 | 8.4 (1.8) | 8.6 (1.4) | 7.2 |
| C: De-prescribing criteria. Need for continued use should be reassessed4 | ||||
| 27. Anti-psychotics | 7.6 (1.9) | 9.5 (1.4) | 9.7 (0.8) | 8.9 |
| 28. Anti-depressants | 8.6 (0.9) | 9.9 (0.2) | 10.0 (0.0) | 10.0 |
| 29. Urologic spasmolytics | 8.9 (1.6) | 9.7 (0.7) | 9.9 (0.4) | 9.5 |
| 30. Anticholinesterase inhibitors | 9.4 (1.1) | 9.8 (0.4) | 9.9 (0.7) | 9.2 |
| 31. Drugs that lower blood pressure | N/A2 | 9.9 (0.5) | 10.0 (0.2) | 9.8 |
| 32. Bisphosphonates | N/A2 | 9.7 (0.9) | 9.9 (0.4) | 9.5 |
| 33. Statins | 9.1 (1.3) | 9.7 (0.9) | 9.9 (0.5) | 9.4 |
| 34. General use of preventive medication | N/A2 | 9.6 (1.0) | 9.9 (0.4) | 9.5 |
Notes: 1The clinical relevance for each of the criteria is scored (from 1 to 10) by a panel of experts during a three-round consensus process. Figures are mean scores with standard deviation, MS (SD). 2Final score (column to the right) is mean score in round 3 minus 1 SD in round 3. To be included on final NORGEP-NH list, final score should be > 5. 3Not available, this denotes criteria first entered into the Delphi process in round 2. 4More details are given in Table I.