eTable. HIOPP-3-iTBX study: a pragmatic complex intervention comprising four elements to increase drug therapy safety in nursing homes.

Who/what	Content and procedure	Framework	How often	Mandatory
1. Medication review
Pharmacists	ATHINA medication review	Duration approximately 1 h per resident	One-off	Yes
2. Training programs/further training
Pharmacists	ATHINA training program	16 Hours	One-off	Yes
	HIOPP training program	8 Hours	One-off	Yes
Physicians	Training program Medication management and PIM/neuroleptic drugs in nursing homes	2-Hour group session; individual training session in the practice or by telephone	One-off	No
Nursing staff	Two further training sessions a) Recognizing adverse drug events b) Managing agitated patients/own role in the prescription of neuroleptic drugs	Approximately 15 min	Twice	No
3. Toolbox
Med-Check fax	Pharmacist sends recommendations to general practitioner; general practitioner transmits any necessary instructions to the nursing home	Joint use by pharmacist and general practitioner with transmission to the nursing staff	One-off	Yes
Drug therapy safety (AMTS) card with additional info card for nursing staff	Essential content of geriatric drug therapy safety at a glance	Provision of information for nursing staff, general practitioners, and pharmacists	Continuous	No
PRISCUS list	List of potentially inadequate medications for older patients and treatment alternatives	Provision of information for nursing staff, general practitioners, and pharmacists	Continuous	No
Treatment monitoring sheet	Structured guide to recognizing and documenting new health complaints	Nursing staff	Continuous	No
Hospital discharge tool	Information from the home for the general practitioner after hospital discharge, feedback from general practitioner possible	General practitioners, nursing staff	Upon hospital discharge	No
Ward round tool	Sheet for structured recording of decisions taken during a joint round	General practitioners, nursing staff, pharmacists	On ward rounds	No
4. Change management
Interdisciplinary – Pharmacists – Physicians – Nursing staff	1. Kick-off session – Current situation and analysis of strengths/weaknesses – Jointly agreed changes in medication management: plan of action – Presentation of the toolbox 2. Half-time session – Feedback on implementation and forwarding of medication reviews – Feedback on initial changes: obstacles and opportunities – Fresh motivation 3. Closing session – Experiences: useful/effective versus short-term/ineffective change – Consolidation in routine care – Boundary conditions required for change	2 Hours 1 Hour 1 Hour	Three sessions	No

“AMTS,” German interventional studies on drug therapy safety; ATHINA, drug therapy safety in German pharmacies; HIOPP, German primary care physicians’ initiative to optimize patient safety in polypharmacy; PIM, potentially inadequate medications