After a written survey in the first round, the panelists met face to face and re-rated the criteria following group discussion. Again, all statements on which consensus could be achieved were published as explicit criteria. Table 2 is exclusively from the 1997 study. It lists drugs that should be avoided in patients with specific concomitant disease states. While not all of these are absolute contraindications, use of the agents in the situation described will increase the likelihood of medication-related problems.
Many possible uses come to mind.
First, if any of the drugs listed in Table 1 are on the formularies of nursing or other elder-care facilities, they should likely be removed. For consultant pharmacists, use of any of these drugs should be a red flag during drug regimen review. Unless some extenuating circumstance is present, the consultant pharmacist should insist upon drug discontinuance. For staff in-service education, a series of presentations comes to mind. First, the need for improved medication therapy can be established using the Phase I Fleetwood data,1 and then specific criteria for reducing the risk of medication-related problems can be presented using Table 1.