Article

Medication review in hospitalised patients to reduce morbidity and mortality

Department of Clinical Pharmacology, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark, 2400.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2013; 2(2):CD008986. DOI: 10.1002/14651858.CD008986.pub2
Source: PubMed

ABSTRACT

Elderly patients are often prescribed several drugs, which increases the risk of drug related harms and the risk of not using the drugs as prescribed, both of which can result in increased costs. A systematic reassessment and possible change of the individual patient's prescriptions in order to optimise therapy is sometimes referred to as a medication review. We aimed to assess whether such medication review may improve the health of adult patients. To find studies we searched electronic databases. We included five randomised controlled trials (RCTs) with a total of 1186 participants. We found that medication review had uncertain effects on death and hospital readmissions, but seemed to reduce emergency department contacts. However, because only a small number of participants were followed for a short time period, important treatment effects may have been overlooked. We therefore suggest that further research is undertaken before implementing medication review.

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    • "Medication errors have multiple potential causes and can occur throughout the prescribing–dispensing process111213. Although several interventions to improve prescribing have been developed, their effect has yet to be established14151617. The lack, or poor quality, of therapeutic information recorded in the medical record (MR) is frequently mentioned as a cause of medication errors [7,181920212223. "
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    ABSTRACT: Rationale, aims and objectivesStructuring the diagnostic section of the medical record (MR) improves diagnosis and communication between doctors. However, little is known about the therapeutic section of the MR. The aim of this study was to gain insight into the extent to which MRs are structured for therapeutic information, to determine which therapeutic data registrars and clinical consultants consider should be recorded in the MR and to what extent registrars record this information themselves.MethodsA multicentre observational study was carried out in the internal medicine outpatient clinics of five teaching hospitals in the Netherlands. Preformatted structure, importance and actual recording of therapeutic information was compared with a reference list of 35 therapeutic items based on the WHO Guide to Good Prescribing (e.g. drug name, indication for drug).ResultsThe preformatted structure of four paper MRs and one electronic MR was assessed. Eight of the 35 therapeutic items were listed in the paper MRs and 18 items in the electronic MR. Registrars and consultants agreed on the importance of recording most of the therapeutic items in the MR, 25 and 27 out of the 35 items, respectively; however, registrars recorded only 11 of the 35 items in the paper MR and 20 of the 35 items in the electronic MR.Conclusions The structure and content of paper and electronic MRs are not adequate. While both registrars and consultants agree on the importance of recording therapeutic items in the MR, registrars fail to record most of this information in practice. The results of this study can be used as starting point for the discussion regarding the necessity of structured recording of therapeutic information in the MR and its possible benefits with regard to medication safety and training of the new generation of prescribers.
    Full-text · Article · Sep 2015 · Journal of Evaluation in Clinical Practice
    • "This makes it all the more difficult to meticulously define what it means to prescribe drugs appropriately in older people [8]. Systematically and regularly reviewing all drugs in older patients is one of several solutions, although more evidence is necessary to establish its benefits for older patients [5] [9] [10]. The use of screening tools in this regard has already been discussed previously [11] [12]. "
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    ABSTRACT: Background Inappropriate prescribing is prevalent in older people. One of the interventions is to optimize geriatric pharmacotherapy with a screening tool to detect potentially inappropriate prescribing. The aim of this study was to develop a novel instrument, the RASP list, which was adapted from The Screening Tool of Older Persons’ potentially inappropriate Prescriptions criteria. Methods Face validity, usability and time investment were determined. Content validity was verified with the Content Validity Index (CVI) and the modified kappa index (κ*). Cohen's kappa (κ) was used to determine the inter-rater reliability. Content and reproducibility validation were to be repeated if consensus (κ* ≥ 0.74) could not be reached in the first round or if new compelling evidence was published. Results Ten experts validated the content of RASP 1.0. The scale-CVI/Average (S-CVI/Ave) was 0.936, Three items did not reach κ* ≥ 0.74. Median time to complete a patient case with RASP 1.0 was 316 seconds. Inter-rater reliability was determined by 9 pharmacists (κ = 0.71) and 10 geriatricians (κ = 0.63). In a second validation round, 15 items were added to and 3 items deleted from RASP 1.0. Nine experts validated the new content of RASP 2.0. All new items but one reached a κ* ≥ 0.74. The S-CVI/Ave was 0.923. Inter-rater reliability of RASP 2.0 was performed by 14 pharmacists (κ = 0.77). The final version of the RASP list contained 76 items. Conclusions The RASP list is a reliable (κ = 0.77) and valid (S-CVI/Ave = 0.92) screening tool to identify polypharmacy in older persons. Further research concerning clinical relevancy is warranted.
    No preview · Article · Jun 2014 · European geriatric medicine
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    • "Benefits of ADR profiling may be confined to the specific problems identified, such as pain, stiffness, dehydration, and oral care, and not reflected in global measures. Cochrane reviews (including 1186 and 7653 patients) suggest that mortality and readmission to hospital may be insufficiently sensitive to medication review [13, 91]. Similarly, instruments, such as the CRBRS or Bartel's index [72, 92] or quality of life or behaviour measures [93], while useful when comparing populations, may be insufficiently responsive to subtle but important changes, such as improved oral care, rendering them less suitable for clinical trials. "
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    ABSTRACT: Objectives. People with dementia are susceptible to adverse effects of medicines. However, they are not always closely monitored. We explored (1) feasibility and (2) clinical impact of nurse-led medication monitoring. Design. Feasibility "before-and-after" intervention study. Setting. Three care homes in Wales. Participants. Eleven service users diagnosed with dementia, taking at least one antipsychotic, antidepressant, or antiepileptic medicine. Intervention. West Wales Adverse Drug Reaction (ADR) Profile for Mental Health Medicines. Outcome Measures. (1) Feasibility: recruitment, retention, and implementation. (2) Clinical impact: previously undocumented problems identified and ameliorated, as recorded in participants' records before and after introduction of the profile, and one month later. Results. Nurses recruited and retained 11 of 29 eligible service users. The profile took 20-25 minutes to implement, caused no harm, and supplemented usual care. Initially, the profile identified previously undocumented problems for all participants (mean 12.7 (SD 4.7)). One month later, some problems had been ameliorated (mean 4.9 (3.6)). Clinical gains included new prescriptions to manage pain (2 participants), psoriasis (1), Parkinsonian symptoms (1), rash (1), dose reduction of benzodiazepines (1), new care plans for oral hygiene, skin problems, and constipation. Conclusions. Participants benefited from structured nurse-led medication monitoring. Clinical trials of our ADR Profile are feasible and necessary.
    Full-text · Article · Feb 2014 · The Scientific World Journal
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