Transcript Red Team ACAT 2012/2013 Audit

FHHS ACAT
2012/2013 Audit
A survey of
prescribing in the frail
elderly with reference
to the STOPP criteria
Rationale
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It is known that adverse drug effects are
common in the elderly people that are our
clients
Certain drugs are potentially inappropriate in
older people because of the higher risk of
side effects due to changes in how the body
processes the drug and due to interactions
between drugs and other illnesses
Rationale
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
It is observed that medication lists provided
with patient referrals do not always reflect
what the person takes on a regular basis
when asked to produce their medications on
a home visit.
It is also observed that older people do not
always receive the assistance that they
require to regularly take their medications
STOPP criteria
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
The Screening Tool of Older Persons
Potentially inappropriate Prescriptions
(STOPP) aims to identify potentially
inappropriate medications that increase the
risk for an adverse drug event in older
patients
This tool was developed in Ireland and
reported in Archived of Internal Medicine in
2001
STOPP criteria
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STOPP criteria include 65 common clinically
significant criteria for potentially inappropriate
prescribing in older people.
These criteria are divided into groups
depending on the drug indication/organ
affected.
AIM

To identify the medications that a
cohort of patients reviewed at home by
an ACAT and determine the
concordance with provided medication
lists, and if the medications taken
could potentially lead to adverse
effects.
Method
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Study group was 192 consecutive people
reviewed at home by the Red Team of
Fremantle ACAT at home during 2012
As is usual practice people were asked to
demonstrate the medications they took on a
regular basis and the mechanism they used
to do this, eg webster pack, box of pills
An assessment was made as to further
assistance required
Method
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Information was sought regarding side
effects including dizziness, sedation, falls, GI
upset, altered mental state and other
HR and postural BP recorded when able
Medical history was recorded at the time of
the visit and also from hospital discharge
letters.
Findings
Subjects
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192 subjects
128 external referrals
119 female, 73 male
Referral Source: 128 clients
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99 GP
Family 11
Social worker 7
Aged care facility 2
RAS 2
FOAMHS 2
Prison 1
ACAT 1
HACC 1
MOSS ST 1
Provision of medication list
 No
Medication list provided on 36
referrals (of 128 in total): 28%
 10/99 of these from GPs did not
provide medication list: 10 %
Accuracy of medication list
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There was a difference between the
medication list provided and the medications
found to be taken in 58 of 92: 63%
Alternatively 34 of 92 lists accurate: 37%
Alternatively 34 of 128 external referrals had
accurate medication list provided: 27%
Number of inaccuracies
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1 inaccuracy: 19
2 Inaccuracies 14
3 Inaccuracies 12
4 Inaccuracies 5
5 Inaccuracies 2
6 Inaccuracies 5
7 Inaccuarcies 1
STOPP criteria category inappropriate
medication
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CVS group 14
CNS 36
GI2
Musculoskeletal 9
Urogenital 8
Endocrine1
Fallers 28
Analgesia 10
Duplicate medication 8
Most Common inappropriate Medications
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1) Long acting benzodiazepines
2) Vasodilator use associated with postural
hypotension
3)Duplicates of same drug class
4)Long term use of strong opiate drugs
5)Long term anti-psychotic use in the
absence of a psychotic psychiatric illness
Conclusions
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The majority of patients did not have an accurate
medication list provided. It is to be assumed that this
would be similar when a patient is referred into
hospital, to outpatient clinics and when received into
residential care
Potential causes would include deficiencies in record
keeping, limitations of computerised medication
summaries, poor transmission of information from
other health care settings, considered/deliberate
non-adherence and lack of required assistance with
medications.
Conclusions

Many of the elderly people seen were taking
medication that could potentially cause them
adverse effects, particularly those that could
increase falls risk, such as long acting
sedatives and medications contributing to
postural hypotension.