Abstract
Introduction With an increasing ageing population, more people are now living with multiple comorbidities and on polypharmacy. Medicines prescribed appropriately provide huge benefits; but inappropriate prescribing without safe optimisation can cause significant harm.
Method We assessed current practices of reviewing and optimising medications in Elderly Care at Maidstone Hospital. 44 Patients were selected randomly from three elderly care wards. We retrospectively evaluated if medications for these patients were reviewed and optimised using the START-STOPP tool at clerking, post take and Geriatrics review.
Results Of the 44 patients screened, 31(70.4%) patients had all their home medications prescribed at the time of clerking but only 23(52%) had their medications reviewed at the time of clerking, based on clear documentation. 11 patients had some of their medications stopped. 23(52%) had their medications reviewed at the time of post take ward round. 19 of the 23(82.06%) had some of their medications stopped. 25(56%) had their medications reviewed at the time of Geriatric review. 15 patients(60%) had their medications stopped. Most medication reviews with clear documentation took place at the time of Geriatrics' review (56%). Least medications were reviewed and stopped at the time of clerking. Most number of patients had their medications stopped at the time of PTWR and geriatrics' review.
Conclusion It is important for admitting teams to ensure all home medications are reviewed and correctly prescribed within 24 hours of acute admission, in keeping with NICE guidelines. This ensures patients do not miss any crucial drugs and also unnecessary medications are stopped, minimising drug related safety-incidents. Least number of drugs were stopped by clerking doctors, which suggests lack of adequate training and low confidence in stopping medications. As such teaching and awareness of junior doctors re: polypharmacy and use of STOPP/START tool is crucial. Electronic clerking proforma prompts will also prove helpful.