Abstract
Introduction:
Polypharmacy and inappropriate prescribing are responsible for a significant number of inimical events in elderly patients, including falls and adverse drug reactions. Given the ageing population in the UK, it is now more essential than ever to ensure medication burden is addressed and potentially inappropriate prescribing is reduced. The START/STOPP criteria for prescribing is a validated, evolving criteria that guides appropriate pharmacotherapy for elderly patients, with the aim of supporting safe prescribing. In this project, our objective was a 20% reduction in inappropriate prescribing (both potentially inappropriate prescriptions and potential prescribing omissions) in four months.
Method:
Randomised data including prescribed medications was collected and analysed using the START/STOPP criteria to evaluate compliance with the guideline. The intervention of a start/stop proforma poster and regular prescriber reminders was then implemented. A further two cycles of the project were carried out to ascertain the impact and consistency of the interventions.
Results:
Preliminary findings showed patients with START/STOPP compliant prescribing increased by 25% and inappropriate prescribing decreased by 62%. Clinician feedback highlighted the utility of the proforma. Key inappropriate prescribing included lack of PPI or statin prescription, and drugs prescribed despite contraindications.
Conclusion:
Compliance with the START-STOPP guidelines improves the quality of patient care and reduces the burden of polypharmacy in the elderly population, which may contribute to a reduction in falls risk. Interventions such as posters and regular reminders of the criteria are feasible and effective tools to combat inappropriate prescribing.
The next steps for this project include ongoing education at grand round, expanding the project into general medicine, and quantitatively assessing the relation to secondary outcomes such as falls or adverse drug reactions.
Comments
Question
Hello. Thank you for presenting your work. What were the limitations / barriers to staff uptake of using the Stopp/start tool and how would you propose to overcome these?
Hello, Thank you for your…
Hello,
Thank you for your question. The main barriers we found in staff uptake were time pressures when combined with the comprehensive geriatric assessment, resident doctors had unfamiliarity with the start stop criteria and some more senior staff were not keen on using a checklist and preferred use of their own knowledge and specialist input.
I think the ways to overcome this are incorporating medication review into the assessment/ e-prescribing or utilising other members of the MDT (pharmacists), providing a teaching session to resident doctors at each turnover point in the year, and framing the proforma as more of a safety net rather than a question of clinical judgement.
Thank you for your poster,…
Thank you for your poster, you highlighted that PPI and statins are two of the key groups that were most prevalent within this cohort, how would you suggest addressing some of these prescribing challenges?
Thank you for your question,…
Thank you for your question, I think addressing these challenges requires a clear medication history that identifies the need and indication for these medications. For example, if a patient has severe acid reflux that is treated with ppi this should be continued, however if the patient is in their late 90s and ppi was started as protection for primary prevention aspirin then this prescription could potentially be stopped. From my perspective, the benefit of a good pharmacy team is paramount for a clear medication history that start/stop can then be applied to.