Can screening tools for potentially inappropriate prescriptions in older adults prevent serious adverse drug events?

Abstract

Purpose The purpose of the study is to identify and explore risk factors of serious adverse drug events (SADE) and SADE-related admissions in acutely hospitalized multimorbid older adults and assess whether these could have been prevented by adherence to the prescription tools Screening Tool of Older Persons' Prescriptions (STOPP) and The Norwegian General Practice (NORGEP) criteria. Methods Cross-sectional study of acutely admitted patients to a medical department in a Norwegian regional hospital. Eligible patients were community-dwelling, receiving home care services, and aged 75+, with ≥ 3 chronic diseases. Medications and information regarding the admission were retrieved from the referral letter and medical records, while an expert panel identified SADE using the Common Terminology Criteria for Adverse Events and SADE-related admissions. Results We included 232 patients. Mean (SD) age was 86 (5.7) years, 137 (59%) were female, 121 (52%) used 5-9 drugs whereas 65 (28%) used ≥ 10. We identified SADEs in 72 (31%) of the patients, and in 49 (68%) of these cases, the SADE was considered to cause the hospital admission. A low body mass index (BMI) and a high Cumulative Illness Rating Scale-Geriatrics (CIRS-G) score were independent risk factors for SADEs. Among the SADEs identified, 32 (44%) and 11 (15%) were preventable by adherence to STOPP and NORGEP, respectively. Conclusions We found a high prevalence of SADE leading to hospitalization. Risk factors for SADE were high CIRS-G and low BMI. STOPP identified more SADEs than NORGEP, but adherence to the prescription tools could only to a limited degree prevent SADEs in this patient group.

Potentially inappropriate prescribing to older patients receiving multidose drug dispensing

“…As with all register-based studies, one cannot conclude if PIMs have led to actual drug-related problems for the patients. A recent study looking at patients with multimorbidity acutely admitted to the hospital, found that strict adherence to the NORGEP-criteria could have prevented 15% of the serious adverse drug reactions [44]. The NORGEP-criteria was published in 2009.…”

The Risks and Outcomes Resulting From Medication Errors Reported in the Finnish Tertiary Care Units:

“…Approximately 50% of MEs result in adverse drug events (ADEs) causing significant increase in patient morbidity and mortality as well as in economic costs in health care (Hohl et al, 2001;Krähenbühl-Melcher et al, 2007;Alhawassi et al, 2014;Classen et al, 2016;Walsh et al, 2017). As ADEs caused by MEs are generally considered preventable, understanding MEs is particularly important when developing and improving preventative methods towards medication-related patient harm (Morimoto et al, 2004;Asaad Assiri et al, 2018;Wang-Hansen et al, 2019).…”

Risk factors for one-year all-cause mortality in elderly multimorbid medical in-patients.

“…Frailty has been shown to be associated with higher mortality, longer in-hospital stay and more complications, also in individuals without multimorbidity (19,21,43). Moreover, previous studies have found multimorbidity (3), polypharmacy (5,44), functional decline 7, low handgrip strength (20), sarcopenia (18,45) and cognitive decline (8) to be associated with one-year mortality. None of these frailty indicators were associated with one-year mortality in our study population.…”