Improving Inpatient Medication Reviews for Older Adults: A Quality Improvement Project at a District General Hospital

Introduction

Polypharmacy is highly prevalent among older adults and is associated with adverse drug events, falls, delirium, and hospital readmissions. In busy inpatient settings, medication reviews may be inconsistent in timing, structure, and documentation. This Quality Improvement Project (QIP) aimed to improve the quality and consistency of inpatient medication reviews for older adults admitted to geriatric wards at Good Hope Hospital.

Method

A prospective audit was conducted across five geriatric wards (Wards 9, 11, 12, 15, and 28). Patients aged ≥75 years prescribed ≥5 regular medications were included. Two audit cycles were undertaken: Cycle 1 (4–28 September 2025, n=54) and Cycle 2 (4–23 December 2025, n=51). Audit standards included medication review within 72 hours of admission, pharmacist involvement, use of STOPP/START criteria, documentation of deprescribing rationale, family/next-of-kin (NOK) discussions, and documentation of medication changes in discharge summaries. Interventions between cycles included introduction of a standardised medication review checklist, ward-based visual prompts, and targeted teaching on STOPP/START and deprescribing during induction.

Results

Improvements were observed across all audit measures between Cycle 1 and Cycle 2. Medication review within 72 hours increased from 91% to 94%, and pharmacist involvement from 89% to 92%. Use of STOPP/START criteria improved from 39% to 68%. Documentation of deprescribing rationale increased from 14% to 44%, family/NOK discussions from 7% to 48%, and documentation of medication changes in discharge summaries from 17% to 58%.

Conclusion

This QIP demonstrates that simple, low-cost interventions—standardisation, education, and visual prompts—can significantly improve the quality of inpatient medication reviews in older adults. The approach is sustainable, MDT-focused, and readily scalable, with direct relevance to patient safety in geriatric practice.