Application of the Beers Criteria to Alternate Level of Care Patients in Hospital Inpatient Units

Abstract

Background:The Beers criteria were developed to help in identifying potentially inappropriate medications (PIMs) for elderly patients. These medications are often associated with adverse events and limited effectiveness in older adults. Patients awaiting an alternate level of care (ALC patients) are those who no longer require acute care hospital services and are waiting for placement elsewhere. They are often elderly, have complex medication regimens, and are at high risk of adverse events. At the time of this study no studies had applied the Beers criteria to ALC patients in Canadian hospitals.Objectives: To determine the proportion of ALC patients receiving PIMs and the proportion experiencing selected PIM-related adverse events. Methods:A retrospective chart review of ALC patients 65 years of age or older was performed to identify PIMs and the occurrence of selected adverse events (specifically central nervous system [CNS] events, falls, bradycardia, hypoglycemia, seizures, insomnia, gastrointestinal bleeding, and urinary tract infections). A logistic regression model with a random intercept for each patient was constructed to estimate odds ratios and probabilities of adverse events.Results: Fifty-two ALC patients were included in the study. Of these, 48 (92%) were taking a PIM. Of the 922 adverse events evaluated, 407 (44.1%) were associated with a regularly scheduled PIM. Among patients who were taking regularly scheduled PIMs, there was a significantly increased probability of an adverse CNS event and of a fall (p < 0.001 for both). The most common PIM medication classes were first-generation antihistamines (24 [46%] of the 52 patients), antipsychotics (21 patients [40%]), short-acting benzodiazepines (15 patients [29%]), and nonbenzodiazepine hypnotics (14 patients [27%]). Conclusions:A high proportion of ALC patients were taking PIMs and experienced an adverse event that may have been related to these drugs. These findings suggest that the ALC population might benefit from regular medication review and monitoring to prevent or detect adverse events.

The impact of a combined intervention program: an educational and clinical pharmacist&rsquo;s intervention to improve prescribing pattern in hospitalized geriatric patients at King Abdulaziz Medical City in Riyadh, Saudi Arabia

“…The incidence rate of PIMs in our analysis was higher than that reported by earlier studies in other countries, which found that the incidence rate of PIMs ranged from 3.5% in France to 46% in Canada. 16 , 17 …”

Medicamentos potencialmente inapropriados (MPIS) para idosos: prevalência em um hospital terciário do Brasil

“…Além destes fatores, a complexidade do local onde o estudo é realizado também influencia no resultado da prevalência, já que muitas vezes em hospitais o uso de MPIs se faz necessário em algumas situações, contrastando com a atenção primária. O uso dos MPIs varia muito entre os diversos países, já que os medicamentos disponíveis para prescrição são distintos, tendo resultados de prevalência de 25,5% a 98,2% [12][13][14][15][16] . Um estudo realizado em um hospital terciário no Brasil apresentou uma alta prevalência do uso dos MPIs, tendo 95,5% dos idosos com pelo menos um MPI prescrito de acordo com o Critério de Beer (versão 2012), sendo a metoclopramida, o ácido acetilsalicílico e o cetoprofeno os MPI mais prescritos 14 .…”

Interventions to Reduce Benzodiazepine and Sedative-Hypnotic Drug Use in Acute Care Hospitals: A Scoping Review

“…Some data suggests high, and potentially inappropriate use, ranging from 27-58% in hospitalized patients. (5)(6)(7)(8) When prescribed in acute care, these medications pose a number of risks including cognitive impairment, falls, fractures, and increased mortality. (9)(10)(11)(12)(13)(14) Furthermore, there is a lack of high quality evidence supporting the bene ts of pharmacologic therapy in hospitalized patients with a sleep disturbance.…”