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Variability of Serum Phenytoin Concentrations in Nursing Home Patients-Reply

Arch Intern Med. 1990;150(4):918-919. doi:10.1001/archinte.1990.00390160158047.
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In Reply. —My colleagues and I thank Stein for his interest in our manuscript published in the April 1989 issue of the Archives.1

He points out an important issue in the long-term care of frail elderly patients. The problem of caring for the elderly nursing home patients are many, not the least of which is the shortage of qualified nurses. We suspect that the problem of medication errors and poor patient compliance is quite prevalent in nursing homes that have staffing problems. Our study, however, was done in an academic nursing home where the administration of medications is monitored by highly qualified geriatric nurse practitioners, as well as a geriatric pharmacy team. We have described the details of this approach in a recent study on drug-drug interactions in the nursing home.2 It is noteworthy that in this latter study we found minimal deficiencies in drug prescribing and administering.


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