228 Potentially Inappropriate Prescribing in Community Nursing Units: Prevalence and Potential for Optimisation

Abstract

Abstract Background It is well researched that individuals in long-term care (LTC) are prescribed a greater number of medications, the leading risk factor for inappropriate prescribing, and are thus at greater risk of adverse drug reactions as a result. Many tools with explicit criteria are described in the literature for assessing potentially inappropriate prescribing (PIP) in the general geriatric population, but few have been developed to examine prescribing in LTC. Methods This was a point prevalence observational study of patients aged >65 years residing in three HSE-run LTC facilities in Cork. Demographic characteristics, medical diagnoses and medication regimes at time of admission (TOA) to LTC, and time of data collection were recorded and reviewed using STOPPFrail and NORGEP-NH criteria. Results 98 patients met the inclusion criteria, with 66% being female. The median age was 83 years (IQR 77-88 years), and median length of stay was 31 months (IQR 14-53 months). The median number of medications per person on admission was 8 (IQR 6-11), which increased to 9 (IQR 7-11) at time of review (TOR)(p<0.001). PIP was found in 70 (84.3%) patients at TOA, and 79(80.6%) at TOR using STOPPFrail, and was recorded as 81 (97.6%) at TOA, and 95(96.9%) at TOR using NORGEP-NH. Among the STOPPFrail criteria most commonly implicated were continuous use of nutritional supplements and high dose PPI therapy. With NORGEP, the most commonly implicated were use of antidepressants and antihypertensives. There was an increase in number of patients prescribed benzodiazepines, z-drugs, anti-depressants and anti-psychotics from TOA to TOR, while statins were prescribed less often at TOR (p<0.001). Conclusion Potentially inappropriate prescribing is highly prevalent in older residents of community hospitals using validated prescribing indicators. Criteria such as those used in this study could be used to highlight potentially inappropriate or futile medications in older, vulnerable patients. Regular medication review is recommended to facilitate deprescribing of such medications.