Minimizing anticholinergic drug prescribing in older hospitalized patients: a full audit cycle

Hui Sian Tay, Roy L. Soiza, Arduino A. Mangoni

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

INTRODUCTION: Anticholinergic drugs are associated with poor outcomes in older patients but no specific intervention strategies aimed at reducing anticholinergic drug exposure have been described.

OBJECTIVES: To identify whether a consultant-led medication review targeting anticholinergics would reduce anticholinergic drug exposure [number of anticholinergic drugs and Anticholinergic Risk Scale (ARS) score].

METHODS: The first phase of the audit included 70 consecutive admissions (mean age 84 years, 53 women). ARS score was calculated on admission and after initial consultant review. Re-audit was undertaken on another 70 consecutive admissions (mean age 83 years, 43 women) after introducing a system of informing the responsible consultant of the ARS score at their first review.

RESULTS: Drugs with anticholinergic effects (n = 53) were prescribed preadmission to 45/140 (32%) of patients. Consultant geriatrician review reduced ARS scores (p = 0.01), especially following the introduction of the information system (p = 0.002). In the first arm of the audit, 51 (73%) patients had ARS of 0 after a consultant's review compared with 47 (67%) patients on admission, whilst 67 (96%) patients had ARS of 2 or less after a consultant's review compared with 63 (90%) patients on admission. In the second arm of the audit, 59 (84%) patients had ARS of 0 after a consultant's review compared with 48 (69%) patients on admission, whilst 70 (100%) patients had ARS of 2 or less after a consultant's review compared with 69 (99%) patients on admission. Anticholinergic drugs were either stopped, or their dose reduced, in 35% of patients in the first arm of the audit and in 73% of patients in the re-audit (odds ratio 5.0, 95% confidence interval 1.4-17.8).

CONCLUSION: Consultant-led medication review (standard practice) was effective at reducing anticholinergic drug exposure in the acute setting. A system of alerting clinicians to patients prescribed anticholinergic medications further reduced anticholinergic drug exposure.

Original languageEnglish
Pages (from-to)121-128
Number of pages8
JournalTherapeutic Advances in Drug Safety
Volume5
Issue number3
Early online date13 Feb 2014
DOIs
Publication statusPublished - Jun 2014

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Drug Prescriptions
Cholinergic Antagonists
Consultants
Patient Admission
Pharmaceutical Preparations

Keywords

  • anticholinergic drugs
  • deprescribing
  • drug withdrawal
  • elderly
  • prescribing

Cite this

Minimizing anticholinergic drug prescribing in older hospitalized patients : a full audit cycle. / Tay, Hui Sian; Soiza, Roy L.; Mangoni, Arduino A.

In: Therapeutic Advances in Drug Safety, Vol. 5, No. 3, 06.2014, p. 121-128.

Research output: Contribution to journalArticle

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abstract = "INTRODUCTION: Anticholinergic drugs are associated with poor outcomes in older patients but no specific intervention strategies aimed at reducing anticholinergic drug exposure have been described.OBJECTIVES: To identify whether a consultant-led medication review targeting anticholinergics would reduce anticholinergic drug exposure [number of anticholinergic drugs and Anticholinergic Risk Scale (ARS) score].METHODS: The first phase of the audit included 70 consecutive admissions (mean age 84 years, 53 women). ARS score was calculated on admission and after initial consultant review. Re-audit was undertaken on another 70 consecutive admissions (mean age 83 years, 43 women) after introducing a system of informing the responsible consultant of the ARS score at their first review.RESULTS: Drugs with anticholinergic effects (n = 53) were prescribed preadmission to 45/140 (32{\%}) of patients. Consultant geriatrician review reduced ARS scores (p = 0.01), especially following the introduction of the information system (p = 0.002). In the first arm of the audit, 51 (73{\%}) patients had ARS of 0 after a consultant's review compared with 47 (67{\%}) patients on admission, whilst 67 (96{\%}) patients had ARS of 2 or less after a consultant's review compared with 63 (90{\%}) patients on admission. In the second arm of the audit, 59 (84{\%}) patients had ARS of 0 after a consultant's review compared with 48 (69{\%}) patients on admission, whilst 70 (100{\%}) patients had ARS of 2 or less after a consultant's review compared with 69 (99{\%}) patients on admission. Anticholinergic drugs were either stopped, or their dose reduced, in 35{\%} of patients in the first arm of the audit and in 73{\%} of patients in the re-audit (odds ratio 5.0, 95{\%} confidence interval 1.4-17.8).CONCLUSION: Consultant-led medication review (standard practice) was effective at reducing anticholinergic drug exposure in the acute setting. A system of alerting clinicians to patients prescribed anticholinergic medications further reduced anticholinergic drug exposure.",
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author = "Tay, {Hui Sian} and Soiza, {Roy L.} and Mangoni, {Arduino A.}",
note = "Funding This research received no specific grant from any funding agency in the public, commercial, or not for-profit sectors.",
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T1 - Minimizing anticholinergic drug prescribing in older hospitalized patients

T2 - a full audit cycle

AU - Tay, Hui Sian

AU - Soiza, Roy L.

AU - Mangoni, Arduino A.

N1 - Funding This research received no specific grant from any funding agency in the public, commercial, or not for-profit sectors.

PY - 2014/6

Y1 - 2014/6

N2 - INTRODUCTION: Anticholinergic drugs are associated with poor outcomes in older patients but no specific intervention strategies aimed at reducing anticholinergic drug exposure have been described.OBJECTIVES: To identify whether a consultant-led medication review targeting anticholinergics would reduce anticholinergic drug exposure [number of anticholinergic drugs and Anticholinergic Risk Scale (ARS) score].METHODS: The first phase of the audit included 70 consecutive admissions (mean age 84 years, 53 women). ARS score was calculated on admission and after initial consultant review. Re-audit was undertaken on another 70 consecutive admissions (mean age 83 years, 43 women) after introducing a system of informing the responsible consultant of the ARS score at their first review.RESULTS: Drugs with anticholinergic effects (n = 53) were prescribed preadmission to 45/140 (32%) of patients. Consultant geriatrician review reduced ARS scores (p = 0.01), especially following the introduction of the information system (p = 0.002). In the first arm of the audit, 51 (73%) patients had ARS of 0 after a consultant's review compared with 47 (67%) patients on admission, whilst 67 (96%) patients had ARS of 2 or less after a consultant's review compared with 63 (90%) patients on admission. In the second arm of the audit, 59 (84%) patients had ARS of 0 after a consultant's review compared with 48 (69%) patients on admission, whilst 70 (100%) patients had ARS of 2 or less after a consultant's review compared with 69 (99%) patients on admission. Anticholinergic drugs were either stopped, or their dose reduced, in 35% of patients in the first arm of the audit and in 73% of patients in the re-audit (odds ratio 5.0, 95% confidence interval 1.4-17.8).CONCLUSION: Consultant-led medication review (standard practice) was effective at reducing anticholinergic drug exposure in the acute setting. A system of alerting clinicians to patients prescribed anticholinergic medications further reduced anticholinergic drug exposure.

AB - INTRODUCTION: Anticholinergic drugs are associated with poor outcomes in older patients but no specific intervention strategies aimed at reducing anticholinergic drug exposure have been described.OBJECTIVES: To identify whether a consultant-led medication review targeting anticholinergics would reduce anticholinergic drug exposure [number of anticholinergic drugs and Anticholinergic Risk Scale (ARS) score].METHODS: The first phase of the audit included 70 consecutive admissions (mean age 84 years, 53 women). ARS score was calculated on admission and after initial consultant review. Re-audit was undertaken on another 70 consecutive admissions (mean age 83 years, 43 women) after introducing a system of informing the responsible consultant of the ARS score at their first review.RESULTS: Drugs with anticholinergic effects (n = 53) were prescribed preadmission to 45/140 (32%) of patients. Consultant geriatrician review reduced ARS scores (p = 0.01), especially following the introduction of the information system (p = 0.002). In the first arm of the audit, 51 (73%) patients had ARS of 0 after a consultant's review compared with 47 (67%) patients on admission, whilst 67 (96%) patients had ARS of 2 or less after a consultant's review compared with 63 (90%) patients on admission. In the second arm of the audit, 59 (84%) patients had ARS of 0 after a consultant's review compared with 48 (69%) patients on admission, whilst 70 (100%) patients had ARS of 2 or less after a consultant's review compared with 69 (99%) patients on admission. Anticholinergic drugs were either stopped, or their dose reduced, in 35% of patients in the first arm of the audit and in 73% of patients in the re-audit (odds ratio 5.0, 95% confidence interval 1.4-17.8).CONCLUSION: Consultant-led medication review (standard practice) was effective at reducing anticholinergic drug exposure in the acute setting. A system of alerting clinicians to patients prescribed anticholinergic medications further reduced anticholinergic drug exposure.

KW - anticholinergic drugs

KW - deprescribing

KW - drug withdrawal

KW - elderly

KW - prescribing

U2 - 10.1177/2042098614523638

DO - 10.1177/2042098614523638

M3 - Article

VL - 5

SP - 121

EP - 128

JO - Therapeutic Advances in Drug Safety

JF - Therapeutic Advances in Drug Safety

SN - 2042-0986

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ER -