Title: Developing a tool to stratify the risk of medication harm in the elderly
Funder: Department of Health (England)

Abstract: Medication-related problems (MRP) often lead to increased mortality and morbidity, involving hospitalisation, longer (and costlier) hospital stays. The prevalence of MRP, especially adverse drug reactions (Adr), in older patients (>65 years), lies between 10 and 27% 1, 2 which leads to a significant percentage of older patients requiring hospital care, when compared to other patient groups (16.6% compared to 4.1%). The findings of a recent large UK study showed that 6.5% of hospital admissions were considered to be a direct result of the medicines they were taking.3 The authors estimated the annual financial burden associated with MRP to the NHS as £466m.3 Local data, collected as part of a service review by the Department of Pharmacy, Guy’s & St Thomas’ Hospital, indicates that 2,780 interventions were made by pharmacists across the trust, during a single week. Over 160 of these related to the 3 elderly care wards, with around 40% associated with managing or preventing medication harm.1 This data suggests that the local elderly population in London is at risk of experiencing medication-related problems Similar data were collected at Brighton & Sussex University Hospital trust in a 7 day period from the 24 January to 30 January 2011 showed that there were 2261 interventions recorded by pharmacy staff. Interventions were classified by 2 pharmacists into 83.2% minor interventions, 11.9% moderate interventions, 4.7% major interventions and 0.13% interventions that prevented catastrophic outcomes. The most common medications causing problems were Warfarin, low molecular weight Heparin, Co-Amoxiclav, Aspirin and Gentamicin. Our study aims to build on existing published evidence and local practice to design a tool to identify elderly patients at greatest risk of experiencing a MRP. The discriminant ability of the tool to stratify the risk of patients will be compared to clinical judgment, made on a medical ward round, at the point of discharge. We hypothesise that the use of a tool to identify patients at risk of experiencing preventable medicines-related problems will better predict MRPs in elderly patients when compared to routine clinical judgment i.e. standard care. This proposal is the initial step in reducing the incidence of medication-related problems in the elderly. The design of a tool which has been demonstrated to better stratify elderly patient’s risk of experiencing a MRP will have positive benefit for both patients and staff. For patients it will reduce medication related harm, potentially reduce hospital readmission as well as serving as a method for better informing patients and their carers about how to monitor their medicine more effectively. For staff such a tool would support the care pathway by providing a systematic approach to prioritizing the ‘at risk’ patients at discharge. This could then be used to communicate important medication related issues to health care staff within both community and secondary care settings.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE