Pharmacist‐led interventions to reduce adverse drug events in older people living in residential aged care facilities: A systematic review

Salahudeen, Mohammed Saji; Bereznicki, Lre; Curtain, Colin

doi:10.1111/bcp.14824

Cited by 22 publications

(52 citation statements)

References 77 publications

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“…The primary outcome of interest was single and multicomponent interventions that improve anticholinergic prescribing practice or reduce adverse drug events due to the consumption of anticholinergic medications. Single-component intervention consists of only one intervention activity, such as medication review [34]. Multicomponent intervention refers to the combination of various components in a single intervention [35], such as medication review and the provision of education [34].…”

Section: Inclusion Criteriamentioning

confidence: 99%

“…Single-component intervention consists of only one intervention activity, such as medication review [34]. Multicomponent intervention refers to the combination of various components in a single intervention [35], such as medication review and the provision of education [34]. All interventions (e.g., medication review, educational detailing visits for physicians, nurses, and aides, pocket-sized educational cards along with clinical vignettes, educational internet site, and detailing session with physicians) performed by any healthcare professional targeting participants of either sex, mean age ≥65 years, and admitted to any healthcare setting were included.…”

Section: Inclusion Criteriamentioning

confidence: 99%

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Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review

Salahudeen

Alfahmi

Farooq³

et al. 2022

JCM

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Background: Pharmacotherapy in older adults is one of the most challenging aspects of patient care. Older people are prone to drug-related problems such as adverse effects, ineffectiveness, underdosage, overdosage, and drug interactions. Anticholinergic medications are associated with poor outcomes in older patients, and there is no specific intervention strategy for reducing drug burden from anticholinergic activity medications. Little is known about the effectiveness of current interventions that may likely improve the anticholinergic prescribing practice in older adults. Aims: This review seeks to document all types of interventions aiming to reduce anticholinergic prescribing among older adults and assess the current evidence and quality of existing single and combined interventions. Methods: We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO from January 1990 to August 2021. Only studies that examined the effect of interventions in older people focused on improving compliance with anticholinergic prescribing guidelines with quantifiable data were included. The primary outcome of interest was to find the effectiveness of interventions that enhance the anticholinergic prescribing practice in older adults. Results: We screened 3168 records and ended up in 23 studies that met the inclusion criteria. We found only single-component interventions to reduce anticholinergic prescribing errors in older people. Pharmacists implemented interventions without collaboration in nearly half of the studies (n = 11). Medication review (43%) and education provision (26%) to healthcare practitioners were the most common interventions. Sixteen studies (70%) reported significant reductions in anticholinergic prescribing errors, whereas seven studies (30%) showed no significant effect. Conclusion: This systematic review suggests that healthcare practitioner-oriented interventions have the potential to reduce the occurrence of anticholinergic prescribing errors in older people. Interventions were primarily effective in reducing the burden of anticholinergic medications and assisting with deprescribing anticholinergic medications in older adults.

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Section: Inclusion Criteriamentioning

confidence: 99%

Section: Inclusion Criteriamentioning

confidence: 99%

Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review

Salahudeen

Alfahmi

Farooq³

et al. 2022

JCM

Self Cite

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“…Two reviews indicated that interactive staff education techniques such as academic detailing showed the most promise for optimising prescribing patterns. 16,18 Academic detailing is an educational outreach that involves face-to-face interaction between prescribing physicians and a group of experts. 16 Finally, Alldred et al 11 mentioned clinical coaching and gerontology education for nurses and caregivers as an intervention, but they did not report whether it was effective.…”

Section: Staff Educationmentioning

confidence: 99%

“…Six reviews briefly mentioned the concept, without examining it in any level of depth. 10,11,13,14,16,18 A final issue raised in the literature concerned the theoretical foundations of primary studies. Only three reviews 10,12,24 discussed conceptual and practical issues regarding RACS staff behaviour change.…”

Section: Multicomponent Interventionsmentioning

confidence: 99%

“…[10][11][12][13][14]16,18 Two of these reviews suggested that more extended follow-up periods and progressive in-house training are essential to ensure sustainability. 16,18 This alludes to the fact that interventions are most effective when they take a systems approach and target multiple stakeholders at different stages of change. 37 As noted above, interventions investigated in this umbrella review are known to be context-dependent.…”

Section: Computerised Clinical Decision Support Systemmentioning

confidence: 99%

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Interventions to Enhance Medication Safety in Residential Aged‐care Settings: An Umbrella Review

Alruthea

Bowman

Tariq

et al. 2021

Brit J Clinical Pharma

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To conduct a systematic synthesis of existing evidence reviews on interventions to enhance medication safety in residential aged-care settings (RACS) to establish and compare their effectiveness.Method: This umbrella review included examination of meta-analyses, scoping and systematic reviews. Four electronic databases were examined for eligible reviews.Two authors critically appraised those meeting the inclusion criteria using the Joanna Briggs Institute Critical Appraisal Instrument. Results: Fifteen reviews covering 171 unique, primary studies were included. Of the variety of interventions identified in the literature, five main categories of interventions were commonly reported to be effective in promoting medication safety in RACS (medication review, staff education, multidisciplinary team meetings, computerised clinical decision support systems and miscellaneous). Most reviews showed mixed evidence to support intervention effectiveness due to the significant heterogeneity between studies in their sites, sample sizes and intervention periods. In all intervention categories, pharmacists' collaboration was most beneficial, showing definitive evidence for improving medication safety and quality of prescribing in RACS. Eight reviews recommended multicomponent interventions, particularly medication reviews and staff education, but specific details were infrequently provided. Only five reviews presented insights into implementation facilitators and barriers, while the sustainability of interventions was only discussed in one review. Conclusion: There is strong evidence to support the four main categories of interventions identified. However, limited details are available regarding the most appropriate design and implementation of multicomponent interventions and the sustainability of all interventions, thus solid recommendations cannot be made. Future research in this field should focus on producing theoretically informed, methodologically robust, original research, particularly regarding the design, implementation and sustainability of multicomponent interventions, which appears the most promising approach.

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Exploring Australian pharmacists' views toward reducing the risk of medicines‐related harm in aged care residents

Curtain

Peterson

Salahudeen

2023

Pharmacology Res & Perspec

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Medicines‐related harm is common in older people living in residential aged care facilities (RACFs). Pharmacists offering services in the aged care sector may play a key role in reducing medicines‐related injury. This study aimed to explore Australian pharmacists' views toward reducing the risk of medicines‐related harm in older residents. Qualitative, semi‐structured interviews were conducted with 15 Pharmacists across Australia providing services (e.g., through the provision of medication reviews, supplying medications, or being an embedded pharmacist) to RACFs identified via convenience sampling. Data were analyzed by thematic analysis using an inductive approach. Medicines‐related harm was thought to occur due to polypharmacy, inappropriate medicines, anticholinergic activity, sedative load, and lack of reconciliation of medicines. Pharmacists reported that strong relationships, education of all stakeholders, and funding for pharmacists were facilitators in reducing medicines‐related harm. Pharmacists stated that renal impairment, frailty, staff non‐engagement, staff burnout, family pressure, and underfunding were barriers to reducing medicines‐related harm. Additionally, the participants suggested pharmacist education, experience, and mentoring improve aged care interactions. Pharmacists believed that the irrational use of medicines increases harm in aged care residents, and medicines‐specific (e.g., sedative load) and patient‐specific risk factors (e.g., renal impairment) are associated with injuries in residents. To reduce medicines‐related harm, the participants highlighted the need for increased funding for pharmacists, improving all stakeholders' awareness about medicines‐associated harms through education, and ensuring collaboration between healthcare professionals caring for older residents.

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Pharmacist‐led interventions to reduce adverse drug events in older people living in residential aged care facilities: A systematic review

Cited by 22 publications

References 77 publications

Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review

Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review

Interventions to Enhance Medication Safety in Residential Aged‐care Settings: An Umbrella Review

Exploring Australian pharmacists' views toward reducing the risk of medicines‐related harm in aged care residents

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