A 1997 report entitled Prescription Drug Use in Nursing Homes, by the Department of Health and Human Services' Office of the Inspector General, states that “patients may be experiencing unnecessary adverse medication reactions as a result of inadequate monitoring of medications.” Of the preventable adverse drug events in nursing homes, 70 percent occurred at the monitoring stage of the medication use process. While clinical informatics systems have focused on the reduction of medication errors at the point of prescribing, dispensing, or administration, few have proposed the use of information technology in the monitoring stage of the medication use process. The authors describe a unique clinical tool for pharmacists and other health professionals—the Geriatric Risk Assessment MedGuide™ (GRAM™)—to reduce serious, preventable adverse drug events occurring during the monitoring stage of the medication use process. The authors focus on the prevention of delirium and falls, as these are two of the most common preventable adverse drug events in nursing homes. With the goal of preventing avoidable medication-related problems, GRAM identifies medications that may cause, aggravate, or contribute to common geriatric problems and facilitates the incorporation of medication-monitoring information in the care plan. Furthermore, the authors describe the real-time integration of the GRAM software with commercial pharmacy software, the development of reports for use in the nursing homes, the development and delivery of GRAM training for nursing facility staff, and early reports of acceptance of the software.