Potentially inappropriate medications (PIMs) in older hospital in‐patients: Prevalence, contribution to hospital admission and documentation of rationale for continuation

Abstract

PIMs were common, and contributed to admission and injury. Hospitalisation provides an opportunity for medication rationalisation, and documentation of rationale for any PIM use.

Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action

“…Hospitalisation provides an opportunity to review medications and conduct deprescribing, however, studies show that levels of polypharmacy and inappropriate medication use do not change during hospitalisation [81,82]. Setting specific barriers to deprescribing includes the focus on acute medical problems, limited time for follow-up and lack of collaboration with different levels of care [43,82,83]. Junior doctors are often responsible for the majority of prescribing activities during hospitalisation.…”

Deprescribing admission medication at a UK teaching hospital; a report on quantity and nature of activity

“…As these factors are not static; monitoring is required to ensure the prescribing does not result in a potentially inappropriate medicine (PIM). PIMs are those which are believed to afford more risks than benefits and are a pre-disposition to harms including adverse drug events, disability and mortality [2]. A multi-centre prospective analysis of older people's admission medication reported PIM prevalence ranging from 34.7% to 77.3% across six European university teaching hospitals [3].…”

Audit‐based measures of overuse of medical care in Australian hospital practice

“…For studies of management strategies (Table ), corresponding rates of overuse comprised: 14–74% of blood product infusions among patients with various conditions ( n = 3) 15–55% of older patients receiving at least one inappropriate medication ( n = 7) 34% of chronically prescribed medications of various classes among older patients ( n = 1) 99% of ondansetron prescriptions in patients with severe emesis ( n = 1) 63–90% of regular prescriptions for gastric acid suppressants in patients admitted to intensive care units ( n = 2) 34% of regular prescriptions of direct oral anticoagulants in patients with various conditions ( n = 1) 21% of antimicrobial prescriptions for patients with acute infections ( n = 1) 52% of prescriptions for inhaled corticosteroids in patients with mild chronic obstructive pulmonary disease ( n = 1) 55% of instances of high flow oxygen therapy administered to patients with chronic obstructive pulmonary disease ( n = 1) 33% of overnight admissions to medical assessment and planning unit for monitoring and evaluation relating to patients presenting to emergency department with undifferentiated chest pain and low coronary risk ( n = 1) 10–64% of end‐of‐life care admissions featuring the administration of futile interventions ( n = 3) …”

“…• 14-74% of blood product infusions among patients with various conditions (n = 3) [21][22][23] • 15-55% of older patients receiving at least one inappropriate medication (n = 7) [24][25][26][27][28][29][30] • 34% of chronically prescribed medications of various classes among older patients (n = 1) 31 • 99% of ondansetron prescriptions in patients with severe emesis (n = 1) 32 • 63-90% of regular prescriptions for gastric acid suppressants in patients admitted to intensive care units (n = 2) 33,34 • 34% of regular prescriptions of direct oral anticoagulants in patients with various conditions (n = 1) 35 • 21% of antimicrobial prescriptions for patients with acute infections (n = 1) 36 • 52% of prescriptions for inhaled corticosteroids in patients with mild chronic obstructive pulmonary disease (n = 1) 37 • 55% of instances of high flow oxygen therapy administered to patients with chronic obstructive pulmonary disease (n = 1) 38 • 33% of overnight admissions to medical assessment and planning unit for monitoring and evaluation relating to patients presenting to emergency department with undifferentiated chest pain and low coronary risk (n = 1) 39 • 10-64% of end-of-life care admissions featuring the administration of futile interventions (n = 3) [40][41][42] Of the eight studies reporting post-audit use of QI strategies, 7,[9][10][11]15,19,21,22 professional education strategies, guideline or pathway dissemination, and implementation of algorithms and other forms of decision support were the dominant strategies used. Of the five studies reporting results of post-QI follow-up audits, 7,9,11,15,19 all relating to use of investigations, absolute reductions in rate of overuse ...…”