Burden to Recovery: Reducing anticholinergic burden in a geriatrician led rehabilitation ward
Abstract
Introduction:
Drugs with anticholinergic properties identified by the anticholinergic burden (ACB) scale are associated with reduced cognitive and functional performance in elderly patients and poorer discharge outcomes. Research indicates that cognitive decline is dose dependent, scaling with cumulative exposure. Reducing ACB provides an opportunity to improve rehabilitation outcomes. The aim of this Quality Improvement Project (QIP) was to reduce the anticholinergic burden of medications for patients in the rehabilitation unit by using a series of interventions encouraging medication review and subsequent reduction in anticholinergic burden.
Method:
A ‘plan do study act’(PDSA) cycle was conducted on a geriatrician led rehabilitation unit. The GP medication list was used on admission to determine a total anti-cholinergic burden score for each patient. Scores were totalled using the ACB calculator and then re-calculated at discharge (or two weeks post admission for ongoing inpatients) to determine any change in anti-cholinergic burden during admission.
Two interventions were employed:
(1) A prompt on the computer to encourage physicians to consider ACB when reviewing medication
(2) A teaching session aimed at clinicians highlighting ACB associated risks, common drugs with high ACB and lower ACB alternatives.
Following implementation of each intervention chronologically, ACB scores were captured to assess cumulative intervention impact with run charts maintained to track progression.
Results:
There was no discernible impact from Intervention (1).
The average ACB significantly decreased after Intervention (2) with a 50% reduction from 1.6 to 0.8 over two weeks post intervention/ prior to patient discharge.
Conclusion:
This QIP indicates that targeted education on anticholinergic burden of common medications and the identification of equivalent alternatives can improve prescribing choices and patient safety.