FHHS ACAT 2012/2013 Audit

A survey of prescribing in the frail elderly with reference to the STOPP criteria

Rationale It is known that adverse drug effects are common in the elderly people that are our clients Certain drugs are potentially inappropriate in older people because of the higher risk of side effects due to changes in how the body processes the drug and due to interactions between drugs and other illnesses

Rationale It is observed that medication lists provided with patient referrals do not always reflect what the person takes on a regular basis when asked to produce their medications on a home visit. It is also observed that older people do not always receive the assistance that they require to regularly take their medications

STOPP criteria The Screening Tool of Older Persons Potentially inappropriate Prescriptions (STOPP) aims to identify potentially inappropriate medications that increase the risk for an adverse drug event in older patients This tool was developed in Ireland and reported in Archived of Internal Medicine in 2001

STOPP criteria STOPP criteria include 65 common clinically significant criteria for potentially inappropriate prescribing in older people. These criteria are divided into groups depending on the drug indication/organ affected.

AIM To identify the medications that a cohort of patients reviewed at home by an ACAT and determine the concordance with provided medication lists, and if the medications taken could potentially lead to adverse effects.

Method Study group was 192 consecutive people reviewed at home by the Red Team of Fremantle ACAT at home during 2012 As is usual practice people were asked to demonstrate the medications they took on a regular basis and the mechanism they used to do this, eg webster pack, box of pills An assessment was made as to further assistance required

Method Information was sought regarding side effects including dizziness, sedation, falls, GI upset, altered mental state and other HR and postural BP recorded when able Medical history was recorded at the time of the visit and also from hospital discharge letters.

Findings

Subjects 192 subjects 128 external referrals 119 female, 73 male

Referral Source: 128 clients 99 GP Family 11 Social worker 7 Aged care facility 2 RAS 2 FOAMHS 2 Prison 1 ACAT 1 HACC 1 MOSS ST 1

Provision of medication list No Medication list provided on 36 referrals (of 128 in total): 28% 10/99 of these from GPs did not provide medication list: 10 %

Accuracy of medication list There was a difference between the medication list provided and the medications found to be taken in 58 of 92: 63% Alternatively 34 of 92 lists accurate: 37% Alternatively 34 of 128 external referrals had accurate medication list provided: 27%

Number of inaccuracies 1 inaccuracy: 19 2 Inaccuracies 14 3 Inaccuracies 12 4 Inaccuracies 5 5 Inaccuracies 2 6 Inaccuracies 5 7 Inaccuarcies 1

STOPP criteria category inappropriate medication CVS group 14 CNS 36 GI2 Musculoskeletal 9 Urogenital 8 Endocrine1 Fallers 28 Analgesia 10 Duplicate medication 8

Most Common inappropriate Medications 1) Long acting benzodiazepines 2) Vasodilator use associated with postural hypotension 3)Duplicates of same drug class 4)Long term use of strong opiate drugs 5)Long term anti-psychotic use in the absence of a psychotic psychiatric illness

Conclusions The majority of patients did not have an accurate medication list provided. It is to be assumed that this would be similar when a patient is referred into hospital, to outpatient clinics and when received into residential care Potential causes would include deficiencies in record keeping, limitations of computerised medication summaries, poor transmission of information from other health care settings, considered/deliberate non-adherence and lack of required assistance with medications.

Conclusions Many of the elderly people seen were taking medication that could potentially cause them adverse effects, particularly those that could increase falls risk, such as long acting sedatives and medications contributing to postural hypotension.