Benzodiazepines were prescribed for approximately one in three elderly hospital inpatients and a large proportion was inappropriate. A multidisciplinary intervention based on audit and feedback improved prescribing and the impact of the intervention was still evident after 6 months.

Application of criteria of appropriate neuroleptic prescribing in a random sample of nursing homes identified suboptimal prescribing to elderly residents.

These prescribing indicators are sensitive to inappropriate prescribing for elderly medical inpatients and cover a wide range of therapeutic areas. They should enable changes in prescribing quality to be measured objectively. Interhospital variation in casemix resulted in substantial differences in the proportion of patients in whom it would have been appropriate to prescribe specific drugs or combinations and prevented derivation of reference ranges of optimal prescribing for four indicators.

To identify and improve suboptimal prescribing for elderly patients we have developed a number of prescribing indicators which focus on areas of concern and allow evaluation of the benefit of interventions. We report here on fourteen indicators

Enquirers and an independent expert panel both determined that MI services provided useful patient-specific advice that impacted positively on patients. Reduction of risk was central to this impact. MI pharmacists frequently identified and advised on issues that clinicians using the service had not recognised themselves, this generally had a positive impact on patients.