Primary Author:	Mike McMurry, MSN, RN, ACNP-BC
Co-Principal Investigators/Collaborators:	Elizabeth A. Thomas, PhD, MPH, RNC, Rebecca Sleeper-Irons, Pharm.D, FASCP, BCPS, Charles Seifert, Pharm.D, FCCP, BCPS
Organization	Texas Tech University Health Sciences Center Anita Thigpen Perry School of Nursing

Abstract

Purpose

To identify the frequency of occurrence of PIM in patients ≥ 65 years of age at admission and discharge from a community hospital.

Background

Yearly more than two million Americans experience adverse drug reactions (ADRs), resulting in more than 100,000 fatalities and 1.5 million hospitalizations. This trend is increased exponentially as the number of medications per individual rises. Failure to detect potential inappropriate medications (PIM) may further increase polypharmacy, ADRs, drug-drug interactions, hospitalizations, and increased health care costs.

Materials & Methods

Retrospective chart review of inpatient hospital records of patients (≥ 65 years of age), admitted to the hospital during a three month period. Chart data reflecting admission (Time 1) and discharge (Time 2) were examined. PIM identification involved a two-step process; review of data first using ICD-9 codes followed by a review using the Screening Tool Older People’s Potentially Inappropriate Prescriptions (STOPP).

Results

In 128 charts reviewed, applying ICD-9 codes, PIM rate at admission was 58 %, PIM rate at discharge was 36 %. Applying STOPP, PIM rate at admission was 28 %, and PIM rate at discharge was 28 %, indicating no difference in PIM rate from admission to discharge. The use of STOPP suggested no improvement in PIM during hospitalization; however use of STOPP requires more complete information in chart documentation (e.g. time length of medication use). Missing data was a prominent factor in the charts reviewed and a limitation of the study.

Conclusion

Use of an explicit screening tool, such as STOPP, after admission may identify PIMs and provide an “entry point” for collaborative drug therapy review between pharmacists and prescribers. STOPP criteria identified PIMs occurring at admission and discharge. However, utility of the STOPP criteria is hindered by documentation practices that routinely omit information necessary to ascertain drug appropriateness. This tool may be used for screening; however it may be most effectively paired with implicit measures by inter-professional teams to reduce PIMs and ADRs in elders.

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