In-Patients Multidisciplinary medication review

Introduction: Preventing adverse drug events (ADEs) is a major priority for NHS and regulatory agencies.

5-17% of hospital admissions are medicine related, and once in hospital 6-17% of older people suffers from adverse drug reaction during their stay.(1)

Problem: Potentially inappropriate prescribing(PIP) in the context of polypharmacy is a key issue in the pharmacotherapy of older age group which inevitably lead to adverse drug events (ADE’s).

Assessment of the problem: There was a noticeable increase in the number clinical incidents documented by pharmacists related to ADEs and drugs errors. Most of our patients had multiple co-morbidities and they were prescribed 5 or more medications.

Methods: We organised weekly multidisciplinary ward roundsin a female rehabilitation ward. This involved pharmacists, senior doctors and senior nurses focused on a detailed review of drug charts. We used STOPPcrieteriaas a guidance for medication review.(2)

Results: 25 female patients were reviewed. Their ages were between 65 to 97 years. The average age was 83years. They had multiple co-morbidities and most of them they were on 5 medications or more. ADE’swere identified in 76% of cases. The most frequently encountred side effects were dizziness with postural hypotention, nausea, constipation, urinary frequency, drowsiness, delirium, renal impairement, electrolytes imbalance and anaemia .67 medications were stopped. Most frequently reviewed medication were diuretics(52%), SSRI(40%) and aspirin(48%),followed by PPI(36%), ACEI (36%), betablocker(28%) and opoids(28%). We optimised patients long term treatment in 64% of cases. Medication where dose/timing/duration were changed in 22% of cases. Indication and duration of antibiotics were documented and reviewed in100% of cases. Following this intervention no inpatient fallswere documented, communication between MDT members has significantly improved and patients were well informed and satisfied about adjustments of their medications.

Lesson learnt: Multidisciplinary medication review should be imbedded in our practice to promote prudent prescribing, ensure a safe pathway to prevent drug errors between a clinician's decision to prescribe a medication and the patient actually receiving it. It is safer approach to identify PIP and prevent drug erros.

Strategy for change: Communicate our approach locally. Patients were involved in every step of our intervention. We improved communication between MDT members and between primary and secondary care.

Reference:

1- National service Framework for older people, 2001

2- Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment): Consensus Validation. Int J Clin Pharmacol Ther 2008; 46(2): 72 – 83. PMID 18218287.