Fig. 1

The medication review process: 1: Researchers educated nursing home staff (“COSMOS ambassadors”), physicians, and nursing home leaders in safe use of drugs and the medication review intervention. 2: The COSMOS ambassadors used the lessons from the education to train the other staff in their units. 3: The researchers trained the nursing home staff in assessing the patients’ pain, neuropsychiatric symptoms, cognition, daily function, and quality of life. 4: Multidisciplinary medication reviews with the researchers, nurses, and nursing home physician were performed in each unit. The researcher gave collegial mentoring for the other participants. The results from the clinical assessments were used in evaluation of the prescriptions for each patient. 5: After two months, the nursing home staff was gathered for a midway evaluation to discuss promotors and barriers towards the implementation among themselves and with the researchers. 6: During the whole study period, the researchers regularly called the COSMOS ambassadors to follow up on the implementation. The researchers gave advice on how to overcome barriers, and collected practical tips from the COSMOS ambassadors that could be spread to other units