Adverse Outcomes in Relation to Polypharmacy in Robust and Frail Older Hospital Patients.

Objective: To explore the relationship between polypharmacy and adverse outcomes among older hospital inpatients stratified according to their frailty status.

Design And Setting: A prospective study of 1418 patients, aged 70 and older, admitted to 11 hospitals across Australia.

Measurements: The interRAI Acute Care (AC) assessment tool was used for all data collection, including the derivation of a frailty index calculated using the deficit accumulation method.

Algorithm of medication review in frail older people: Focus on minimizing the use of high-risk medications.

Aim: Frail older people typically suffer several chronic diseases, receive multiple medications and are more likely to be institutionalized in residential aged care facilities. In such patients, optimizing prescribing and avoiding use of high-risk medications might prevent adverse events. The present study aimed to develop a pragmatic, easily applied algorithm for medication review to help clinicians identify and discontinue potentially inappropriate high-risk medications.

Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities.

Objective: In Australian residential aged care facilities (RACFs), the use of certain classes of high-risk medication such as antipsychotics, potent analgesics, and sedatives is high. Here, we examined the prescribed medications and subsequent changes recommended by geriatricians during comprehensive geriatric consultations provided to residents of RACFs via videoconference.

Design: This is a prospective observational study.

Deciding when to stop: towards evidence-based deprescribing of drugs in older populations.

Minimising the harm from inappropriate prescribing in older populations is a major urgent concern for modern healthcare systems. In everyday encounters between prescribers and patients, opportunities should be taken to identify patients at high risk of harm from polypharmacy and reappraise their need for specific drugs. Attempts to reconcile life expectancy, comorbidity burden, care goals and patient preferences with the benefits and harms of medications should be made in every patient at significant risk.

Effects of a drug minimization guide on prescribing intentions in elderly persons with polypharmacy.

Background: While frameworks exist to assist clinicians in prescribing appropriately in older patients at risk of adverse drug reactions, their impact on prescribing is uncertain.

Objective: The aim of the study was to determine the effects of a ten-step drug minimization guide on clinician prescribing intentions involving a hypothetical older patient receiving multiple drugs.

Methods: A total of 61 hospital clinicians were presented with clinical information about a hypothetical case: an 81-year-old female with 12 chronic diseases, receiving 19 different medications.

Minimizing inappropriate medications in older populations: a 10-step conceptual framework.

The increasing burden of harm resulting from the use of multiple drugs in older patient populations represents a major health problem in developed countries. Approximately 1 in 4 older patients admitted to hospitals are prescribed at least 1 inappropriate medication, and up to 20% of all inpatient deaths are attributable to potentially preventable adverse drug reactions. To minimize this drug-related iatrogenesis, we propose a quality use of medicine framework that comprises 10 sequential steps: 1) ascertain all current medications; 2) identify patients at high risk of or experiencing adverse drug reactions; 3) estimate life expectancy in high-risk patients; 4) define overall care goals in the context of life expectancy; 5) define and confirm current indications for ongoing treatment; 6) determine the time until benefit for disease-modifying medications; 7) estimate the magnitude of benefit versus harm in relation to each medication; 8) review the relative utility of different drugs; 9) identify drugs that may be discontinued; and 10) implement and monitor a drug minimization plan with ongoing reappraisal of drug utility and patient adherence by a single nominated clinician.

Standardising practices through form design and education improves insulin management.

Diabetes is common in hospitalised patients and insulin is frequently required for management. Insulin is a high-risk drug, accounting for about 15% of reported medication-related incidents. Despite its complexity, insulin management in hospitals is often undertaken by junior and non-specialist staff.

Safe medication practice: attitudes of medical students about to begin their intern year.

Objectives: Interns are expected to prescribe effectively and safely. This study aimed to assess medical students' perceptions of their readiness to prescribe, associated risks and outcome if involved in an error, as well as their perceptions of available support.

Methods: We carried out a survey of 101 students prior to their intern year using a structured questionnaire.