Potentially Inappropriate Drug Prescriptions and Risk of Hospitalization among Older, Italian, Nursing Home Residents

Ruggiero, Carmelinda; Dell’Aquila, Giuseppina; Gasperini, Beatrice; Onder, Graziano; Lattanzio, Fabrizia; Volpato, Stefano; Corsonello, Andrea; Maraldi, Cinzia; Bernabei, Roberto; Cherubini, Antonio

doi:10.2165/11538240-000000000-00000

Cited by 103 publications

(82 citation statements)

References 24 publications

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“…Greater attention should be given to patients considered at risk, such as the elderly people. Studies have shown that polypharmacy is a risk factor for PIM prescription (Varallo et al, 2011;Ruggiero et al, 2010;Locatelli et al, 2010;Azoulay et al, 2005). Our findings corroborate data of the literature, since older people who used five or more medications had higher number of prescribed PIM when compared with elderly individuals who are not polypharmacy users (p<0.0001).…”

Section: Discussionsupporting

confidence: 90%

“…Other researches show that the prevalence of institutionalized older people who take at least one PIM ranges from 27.6% to 46.2% (Ruggiero et al, 2010;Castellar et al, 2007;Azoulay et al, 2005). The prescription of PIM must follow judicious protocols, since their administration may double the odds of hospitalization of elderly people (Albert et al, 2010), as well as the demand for health services (Fick et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

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Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility

Varallo

Ambiel

Nanci

et al. 2012

Braz. J. Pharm. Sci.

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The present study aimed to estimate the prevalence of elderly using potentially inappropriate medications (PIM) and with occurrence of potentially hazardous drug interactions (PHDI); to identify the risk factors for the prescription of PIM and to evaluate the impact of pharmaceutical intervention (PI) for the prescription of safer therapeutic alternatives. Therefore, a cross-sectional study was performed in a long-term care facility in São Paulo State, between December/2010 and January/2011. The medical records of the patients ≥60 years old who took any drugs were consulted to assess the pharmacotherapeutic safety of the medical prescriptions, in order to identify PIM and PHDI, according to the Beers (2003) and World Health Organization criteria, respectively. PI consisted of a guidance letter to the physician responsible for the institution, with the suggestions of safer equivalent therapeutics. Approximately 88% of the elderly took at least one drug, and for 30% of them the PIM had been prescribed. Most of the PIM identified (53.4%) act on the central nervous system. Among the 13 different DI detected, 6 are considered PHDI. Polypharmacy was detected as a risk factor for PIM prescription. After the PI there was no change in medical prescriptions of patients who had been prescribed PIM or PHDI. The data suggests that PI performed by letter, as the only interventional, method was ineffective. To contribute it a wide dissemination of PIM and PHDI among prescriber professionals is necessary for the selection of safer treatment for elderly. Additionally, a pharmacist should be part of the health care team in order to help promote rational use of medicines.Uniterms: Drugs/interactions. Elderly people/inappropriated use of medicines. Long-term care facility. Medication/errors. Safety management.O presente estudo teve como objetivos estimar a prevalência de idosos em uso de medicamentos potencialmente impróprios (MPI) e com ocorrência de interações medicamentosas potencialmente perigosas (IMPP); identificar os fatores de risco para a prescrição de MPI e avaliar o impacto de intervenção farmacêutica (IF) para a prescrição de alternativas terapêuticas mais seguras. Para tanto, realizou-se estudo transversal em instituição de longa permanência do interior de São Paulo, de dezembro/2010 a janeiro/ 2011. Os prontuários médicos dos pacientes ≥60 anos e que utilizavam pelo menos um medicamento foram consultados para avaliar a segurança farmacoterapêutica das prescrições médicas, identificando-se os MPI e as IMPP, segundo critérios de Beers (2003) e o critério da Organização Mundial da Saúde, respectivamente. A IF constou de carta de orientação ao médico da instituição, com sugestão de equivalentes terapêuticos mais seguros. Aproximadamente 88% dos idosos haviam utilizado pelo menos um medicamento e, para 30% deles, havia pelo menos um MPI prescrito. A maioria dos MPI identificados (53,4%) age no sistema nervoso central. Entre as 13 interações medicamentosas detectadas, 6 são consideradas IMPP. A polimedicação foi detectada c...

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility

Varallo

Ambiel

Nanci

et al. 2012

Braz. J. Pharm. Sci.

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“…[4] Other studies have revealed that residents taking more than 5 and 7 medications were associated with increased hospitalizations. [5,[15][16][17][18] Measures to reduce polypharmacy should be implemented to reduce subsequent hospitalizations. Some initiatives that can be targeted include: omitting PRN orders that have been on the MAR for > 30 days; evaluating for therapeutic duplication and discontinuing/tapering medications, if needed; matching all disease states and drug therapy to determine if there are any gaps between the two; and/or discontinuing/tapering medications associated with adverse drug effects in the elderly population (e.g., Beer's Criteria, STOPP/START criteria, etc.).…”

Section: Polypharmacymentioning

confidence: 99%

“…[2] A medication error is generally defined as any preventable event occurring in the medication use process (e.g., prescribing, transcribing, dispensing, administration, monitoring) that causes (or has the potential to cause) resident harm or inappropriate medication use. [3][4][5] Actual errors are those that reach the resident, prevented errors (or "near misses") are errors that are identified prior to reaching the resident and potential errors are those situations that pose a hazard and may develop into errors. [1,6] Approximately 19%-42% of all medication doses administered in nursing facilities are associated with medication errors.…”

Section: Introductionmentioning

confidence: 99%

Common issues in the medication use processes in nursing homes: a review of medication use quality improvement strategies

Hughes

Freeman

Slaton

2016

JNEP

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Background: A continuous evaluation of safety practices in nursing homes and long-term care (LTC) facilities is needed. Numerous studies have highlighted the deficiencies in safety processes of nursing homes compared with institutional practice despite the fact that many residents in the nursing home setting also suffer from complex medical conditions and are receiving multiple medications to treat the comorbidities. As part of larger grant initiative, an extensive search was conducted to identify common problems in nursing facilities and potential strategies for improvement. This review highlights common problems in the medication use process in nursing facilities and strategies to improve processes and general resident safety based upon pertinent findings from the literature. Findings: There are proven medication safety strategies utilized in institutions that should be a foundational practice in nursing and LTC facilities. These strategies include, but are not limited to, reduction of polypharmacy and increased sensitivity to and prioritization of medication therapy monitoring processes, which will assist in the creation of a culture of safety. Specific goals of this process includes frequent education and encouraged use of best practices surrounding handling of high-alert medications, proper drug administration (e.g., crushing medications), drug interactions and reporting of adverse medication events. Conclusion: Medication use process failures are common in nursing and LTC facilities. However, an integrated approach can be used to mitigate some of the common problems. Pharmacists and nurses should work more closely to implement proven medication safety strategies. Implementing these strategies in concert with improved communication between team members can benefit residents by preventing avoidable events and hospitalizations.

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“…However, the previous versions of Beers criteria have been criticised because of the lack of a reproducible association with ADRs and adverse health outcomes, and the inclusion of medication as being absolutely contra-indicated irrespective of the diagnosis (115)(116)(117)(118). Numerous nationally adapted criteria have been developed and partially overlap (108)(109)(110)(111).…”

Section: Explicit Potentially Inappropriate Prescriptions Criteriamentioning

confidence: 99%

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

Hedna

2015

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Aim:The aim of this thesis is to estimate and analyse the burden of potentially inappropriate prescriptions (PIPs) in the elderly and non-adherence to long-term medications among adults across care settings, and to investigate how IUM is associated to DRMs. Methods:A meta-analysis summarised the previous evidence on the percentage of adverse drug reactions (ADRs) associated to IUM across healthcare settings (Study I). From a cohort in the general population, using medical records and register data, the prevalence of PIPs in the elderly and its association with ADRs were estimated retrospectively (Study II). From the same cohort, the factors associated with refill non-adherence to antihypertensive therapy, considering the use of multiple medications, and the association between non-adherence and sub-therapeutic effects (STEs) were investigated (Study III). A survey assessed the refill behaviour to antihypertensive, lipid lowering and oral antidiabetic medications (undersupply, adequate supply and oversupply), and its association with perceived ADRs and STEs (Study IV).Results: IUM was the cause 52% and 45% of ADRs occurring in adult outpatients and inpatients respectively. Across healthcare settings, 46% of the elderly refilled PIPs over a 6-month period;PIPs were considered the cause of 30% of all ADRs; and the elderly who were prescribed PIPs had increased odds to experience ADRs (OR 2.47, 95% CI 1.65-3.69). In total, 35% was nonadherent to the full multidrug therapy and 13% was non-adherent to any medication (complete vi non-adherence). Sociodemographic factors (working age and lower income) were associated with non-adherence to any medication, while clinical factors (use of specialised care, use of multiple medications, and being a new user) with non-adherence to the full multidrug therapy. STEs were associated with non-adherence to any medication a month prior to a healthcare visit (OR 3.27, 95% CI 1.27-8.49), but not with long-term measures of non-adherence. Among survey respondents, 22% of the medications were oversupplied and 12% were undersupplied. Inadequate refill behaviour was not associated with reporting ADRs or STEs (p<0.05). Conclusions:A large proportion of ADRs occurring in hospital is caused by IUM, but more knowledge is needed in other settings. PIPs are common in the elderly general population and associated with ADRs. Therefore decreasing PIPs could contribute towards ADR prevention.Considering the use of multiple medications may help to better understand the factors associated with non-adherence to a multidrug therapy for tailoring the interventions to patient needs.Monitoring the adherence prior to a healthcare visit may facilitate interpreting STEs. Yet, the absence of an association between long-term measures of refill non-adherence with clinical and perceived DRMs suggest the need to enhance the knowledge of this association in clinical practice.In summary, this thesis shows a significant potential for improvements of medication use and outcomes.Key words: Drug-related morbidity, medica...

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Potentially Inappropriate Drug Prescriptions and Risk of Hospitalization among Older, Italian, Nursing Home Residents

Abstract: PIDP is a significant problem among Italian NH residents. There is an urgent need for intervention trials to test strategies to reduce inappropriate drug use and its associated adverse health outcomes.

Cited by 103 publications

References 24 publications

Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility

Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility

Common issues in the medication use processes in nursing homes: a review of medication use quality improvement strategies

Inappropriate prescribing, non-adherence to long-term medications and related morbidities : Pharmacoepidemiological aspects

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