Abstract
Introduction:
Polypharmacy is a highly prevalent challenge in geriatric care, particularly concerning patients with cardiovascular conditions. The STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria are recognized tools designed to optimize medication regimens in older adults by identifying potential omissions and potentially inappropriate prescriptions. This project aimed to evaluate and improve adherence to the STOPP/START criteria for cardiovascular and coagulation medications among older people, aiming to enhance prescribing practices and patient outcomes.
Method:
We conducted a retrospective review of 80 consecutive patients, aged 65 years and older, discharged from the geriatrics ward of a community hospital. Data was collected from electronic healthcare records and included demographics, baseline characteristics and medications, and adherence to STOPP/START criteria on discharge. Interventions implemented post-audit comprised the development of educational posters, targeted teaching sessions with medical and pharmacy teams, and subsequent data collection to assess improvements in knowledge.
Results:
The mean patient age was 84.1 years and 62.5% (n=50) were female. The mean total length of stay (i.e., in the acute and community hospital wards) was 29.5 (±15.7) days. A total of 125 applicable STOPP/START criteria were identified: 49 STOPP (cardiovascular), 18 STOPP (coagulation), 55 START (cardiovascular), and 3 START (coagulation). Overall adherence was 38.4% (48/125). Adherence rates were higher for STOPP criteria: 49.0% for cardiovascular and 61.1% for coagulation medications. START criteria adherence was notably lower: 23.6% for cardiovascular and 0% for coagulation medications. Post-intervention assessments indicated improved prescriber knowledge and satisfaction.
Conclusions:
The audit revealed suboptimal adherence to STOPP/START criteria, particularly regarding the initiation of indicated medications (START criteria). The educational interventions implemented were associated with enhanced prescriber awareness. Extending the audit to additional community hospitals is anticipated to further improve prescribing practices and patient safety in the wider setting.
Comments
Feedback on Poster
Hello. Thank you for sending in this poster to share. Firstly, it is presented really clearly. As geriatricians we are often focused, appropriately, on deprescribing, but it is interesting to see you also looked into the START criteria - good to be reminded on what medications are effective to continue. The STOP/START criteria is also a good tool to be reminded of as it is one that can be shared and used by so many MDT members who prescribe - may look into reviewing the use of that tool in future in our local area.