Preventing Prescribing Cascades: Ensuring Medication Safety for Older Adults.

Purpose: To define prescribing cascades (PCs) and provide tools to identify PCs, including the most common PCs described in the literature. PCs lead to the accumulation of medications prescribed to older adults, disproportionately affecting those who often have additional health care complexities, such as multiple chronic conditions and multiple transitions of care.

Method: Review of recent research efforts to identify and describe evolving clinical practice interventions to detect and reverse PCs.

Association between potentially inappropriate medications prescription and health-related quality of life among US older adults.

Background: Potentially inappropriate medications (PIMs) are associated with worse health outcomes among older adults. Our objective was to examine the association between PIM prescription and health-related quality of life (HRQoL) among older adults in the United States using nationally representative data.

Methods: This was a retrospective study utilizing 2011-2015 Medical Expenditure Panel Survey (MEPS) data.

Medication Use Among Patients Reporting Xerostomia of an Academic Dental Clinic.

Background: Global prevalence of xerostomia has been reported at 22% (range 0.01%-45%), negatively impacting oral health, nutrition intake, and quality of life. The causal relationship between xerostomia and medications remains uncertain but greater understanding could guide interventions.

Targeted Medication Review of Falls-Risk Medications in Older Patients: A Community Pharmacy-Based Approach.

To assess a community pharmacist-provided targeted medication review (TMR) intervention to reduce the number of falls risk-increasing drugs (FRIDs) prescribed to older patients in a community pharmacy setting. A single-site, prospective, interventional pilot study with a historical control group. A single independent community pharmacy in rural Western New York.

Development of video animations to encourage patient-driven deprescribing: A Team Alice Study.

Objective: Patient-driven deprescribing initiatives aim to increase patient knowledge and strengthen self-advocacy skills. This article describes the development of three animated videos designed to educate older adults about unsafe prescribing and medication harm, based on the actionable lessons from the death, by polypharmacy, of an older adult in our community.

Methods: Using a community based participatory research approach (CBPR), members of three senior centers (n = 53) and the Deprescribing Partnership of Western New York (n = 30) were recruited and participated in two rounds of focus groups to guide the video development.

Trends in fall-related mortality and fall risk increasing drugs among older individuals in the United States,1999-2017.

Background: Previous studies have demonstrated increasing mortality due to falls among older adults. The objective of this study was to determine whether there was an increase in fall risk increasing drug prescribing and if this is concurrent with an increase in fall-related mortality in persons 65 years and older in the United States.

Methods: The study is a serial cross-sectional analysis utilizing data from both the National Vital Statistics System (NVSS) and the medical expenditure panel survey (MEPS) for years 1999-2017.

Knowledge and Attitudes of Student Pharmacists Regarding Polypharmacy and Deprescribing: A Cross-Sectional Study.

Pharmacists play a key role in deprescribing medications. Incorporation of this concept into pharmacy school curricula is important in ensuring that graduates can address the complex needs of an aging population. The aims of this study were to assess if and how student pharmacists were exposed to deprescribing within their curriculum, to assess students' perceptions regarding their attitudes, ability and confidence in deprescribing, and to assess if reported curricular exposure to this topic resulted in improved perceptions or objective knowledge assessment scores.

Student Pharmacist Perceptions of the Utility of a Medication Therapy Management-Based, Medication-Related, Falls Risk-Assessment Tool.

To evaluate student pharmacists' perceptions of the Medication Fall Risk-Assessment Tool (MFRAT), a novel medication therapy management (MTM)-based clinical decision support tool.
A cross-sectional study
One school of pharmacy
Participants were eligible if they had used the MFRAT as part of a wellness clinic or as part of required coursework prior to April 2016.
An online, author developed survey was distributed to assess previous MFRAT use, perceptions of the tool on a 5-point Likert-type scale, and qualitative feedback related in the areas of pharmacy workflow, clinical utility, and perceived patient acceptance.

Opportunities and Recommendations for Improving Medication Safety: Understanding the Medication Management System in Primary Care Through an Abstraction Hierarchy.

Background: Despite making great strides in improving the treatment of diseases, the minimization of unintended harm by medication therapy continues to be a major hurdle facing the health care system. Medication error and prescription of potentially inappropriate medications (PIMs) represent a prevalent source of harm to patients and are associated with increased rates of adverse events, hospitalizations, and increased health care costs. Attempts to improve medication management systems in primary care have had mixed results.

Potentially Inappropriate Medications Are Associated with Increased Healthcare Utilization and Costs.

Background/objectives: To examine the prevalence of potentially inappropriate medication (PIM) prescribing and its association with healthcare utilization and related expenditures utilizing nationally representative data from the United States.

Design: Retrospective cohort study.

Setting: The 2011-2015 Medical Expenditure Panel Survey (MEPS).

Pharmacy Students' Ability to Identify Fall Risk-Increasing Drugs Using an Innovative Assessment Tool.

To evaluate change in the ability of third-year pharmacy students to identify drugs that increase fall risk after training in and experience using the Medication Falls Risk Assessment Tool (MFRAT). An assessment was administered to students prior to MFRAT use and after MFRAT use. The assessment consisted of 10 medication regimens for various chronic conditions (50 distinct drug choices with 30 correct answers and 20 distractors), and students were to identify fall risk increasing drugs (FRIDs).

Interventions to deprescribe potentially inappropriate medications in the elderly: Lost in translation?

What Is Known And Objective: Use of potentially inappropriate medications (PIMs) remains common in older adults, despite the easy availability of screening tools such as the Beers and Screening Tool of Older Person's Prescriptions (STOPP) criteria. Multiple published studies have implemented these screening tools to encourage deprescribing of PIMs, with mixed results. Little is known about the reasons behind the success or failure of these interventions, or what could be done to improve their impact.

A pharmacist-led pilot program to facilitate deprescribing in a primary care clinic.

Objective: To develop and pilot-test a model in which a community-based clinical pharmacist was incorporated as part of a Medicare Annual Wellness Visit (AWV) to make deprescribing recommendations targeted at potentially inappropriate medications (PIMs) in seniors.

Setting: A family medicine patient-centered medical home (PCMH) clinic in Buffalo, NY.

Practice Description: Implementation and evaluation of a pilot program incorporating a pharmacist-provided medication review targeting PIMs in seniors as part of a Medicare AWV.

2018 American Society of Consultant Pharmacists Annual Meeting & Exhibition.

Poster abstracts are evaluated based on the following criteria: significance of the problem to healthy aging or medication management; innovativeness of ideas, methods, and/or approach; methodological rigor of methods and approach; presentation of finding; implications identified for future research, practice, and/or policy; and clarity of writing. Submissions are not evaluated through the peer-reviewed process used by . Industry support is indicated, where applicable.

Nebulized Fentanyl for Dyspnea in a Hospice Patient with True Allergy to Morphine and Hydromorphone.

An 86-year-old white female was admitted to hospice care with lung cancer. Even with optimal medical management, she suffered from dyspnea and required opioid therapy. However, the patient had a true morphine and hydromorphone allergy.

Students Use "STAMP-OUT" Program to Advance Seniors' Knowledge of Drug Misuse.

Unlabelled: This program assessed the impact of student presentations on 30 seniors and sought to improve their knowledge of prescription drug misuse and abuse. The six pharmacy students used the ASCP Foundation's "STAMP Out Prescription Drug Misuse and Abuse Tool Kit." Information presented to senior audiences included descriptions of drug misuse and abuse and preventive measures to uphold medication safety.

Use of Compounded Dextromethorphan-Quinidine Suspension for Pseudobulbar Affect in Hospice Patients.

Background: Pseudobulbar affect (PBA) consists of unprovoked and uncontrollable episodes of laughing and/or crying. In end-of-life situations, PBA symptoms can be especially distressing to family and friends during an already heightened emotional time. Although a commercial product combining dextromethorphan and quinidine (DMQ) is FDA approved for use in PBA, many hospice patients are unable to swallow any solids or semisolids.

Very-high-dose methadone with minimal toxicity and inadequate pain control in a hospice patient with cancer.

A case is reported of a 48-year-old Caucasian male who was admitted to hospice care with metastatic cancer of the larynx. The patient required very high methadone doses and experienced little opioid toxicity. The pharmacodynamics and pharmacokinetics of methadone are discussed in the context of this patient experience.

Morphine and hydromorphone-induced hyperalgesia in a hospice patient.

Opioids including morphine and hydromorphone are widely used for control of moderate to severe pain and dyspnea in hospice and palliative care patients. Accumulation of the active morphine-3-glucuronide (M3G) and hydromorphone-3-glucuronide (H3G) metabolites is one proposed mechanism for the development of neuroexcitatory effects including allodynia and opioid-induced hyperalgesia (OIH). We report the case of a 43-year-old female hospice patient with metastatic non-small cell lung cancer who initially developed allodynia following morphine administration and again following administration of hydromorphone.

A national survey of hospice administrator and pharmacist perspectives on pharmacist services and the impact on medication requirements and cost.

Symptom management at the end of life relies heavily on medications. For this reason, pharmacists are an ideal addition to the interdisciplinary hospice team (IDT). The aim of this study is to characterize the utilization of pharmacists in hospices from the hospice administrator and pharmacist perspectives and to determine the impact utilization has on per diem medication requirement and costs.

Impact of pharmacist intervention on clinical outcomes in the palliative care setting.

Background: Although accepted as an integral part of the interdisciplinary team, pharmacist value in palliative care has predominantly been evaluated by subjective methods. This study was conducted to identify factors that impact physician acceptance of the pharmacist's recommendation and to determine whether acceptance is a significant predictor of clinical outcome.

Methods: As a mandated in-house quality assurance project at Niagara Hospice, Inc, 2 clinical pharmacists tracked each request for pharmacotherapeutic intervention over a 4-month period (April-July 2009).

Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities.

Research shows that after training in the philosophy and practice of mindfulness, parents can mindfully attend to the challenging behaviors of their children with autism. Parents also report an increased satisfaction with their parenting skills and social interactions with their children. These findings were replicated and extended with 4 parents of children who had developmental disabilities, exhibited aggressive behavior, and had limited social skills.