Background: District nurses in Region Stockholm have the opportunity to establish special units at primary health care centers for patients 75 years and older. The units conduct drug utilization reviews and create care plans for older adults.

Aim: To investigate whether district nurses can identify factors related to the quality and safety of medication use among older patients via a clinical decision support system (CDSS) for medication and an instrument for assessing the safety of drug use (the Safe Medication Assessment, SMA tool). A secondary aim was to describe patients’ experiences of the assessment.

Methods: Nine district nurses at seven primary health care centers in Region Stockholm used the tools with 45 patients 75 years and older who used one or more drugs. Outcome measure were the number of drugs, potential drug-related problems, nursing interventions, and patient satisfaction. Prevalences of drug-related problems and nursing interventions were calculated. Eleven patients answered a telephone questionnaire on their experiences of the assessment.

Findings: District nurses identified factors indicative of drug-related problems, including polypharmacy (9.8 drugs per person), potential drug-drug interactions (prevalence 40%), potential adverse drug reactions (2.7 per person), and prescribers from more than two medical units (60%). District nurses used several nursing interventions to improve the safety of medication use (e.g., patient education, initiating a pharmaceutical review). The patients thought it was meaningful to receive information about their drug use and important to identify potential drug-related problems. With the support of the clinical decision support system and the SMA tool, the district nurses could identify several factors related to inappropriate or unsafe medication and initiated a number of interventions to improve medication use. The patients were positive toward the assessments.