Abstract
Drug-related iatrogenesis is an important issue in the elderly population, and preventing iatrogenic accidents helps to reduce hospitalizations. Our study’s objective was to evaluate prescriptions in the geriatric population of our establishment. The study conducted is a targeted clinical audit. Ten criteria were tested on the hospital prescriptions of people over 75 years old in 11 medical departments, before and after improvement actions. The non-compliance threshold was set at 10% of prescriptions for each criterion. In each phase, 165 patients were included. Four criteria were non-compliant (NC) in the first phase: the presence of Potentially Inappropriate Medications for the Elderly (PIMs) (NC = 57.6%), the adaptation of the medication to renal clearance (NC = 24.9%), the presence of illogical combination (NC = 9.7%), and the total anti-cholinergic score of the prescription (NC = 12.1%). After the implementation of improvement actions, the number of non-compliant criteria decreased between the two phases, from four to two. We obtained a significant improvement for three of the four criteria found to be non-compliant in the first phase. The criterion adaptation to renal function is close to compliance (NC = 10.1%) and the PIMs criterion remained non-compliant after reassessment (NC = 32.1%). Vigilance must be ongoing in order to limit drug iatrogeny, particularly in frail elderly patients.
Highlights
On 1 January 2021, 20.7% of the French population was older than 65 years [1]
Thirty-nine percent of these serious adverse events (SAEs) are due to medication, and it is estimated that almost two-thirds are preventable iatrogenic events [5,6]
The aims of this study were: to describe the frequency of non-compliant prescriptions in a geriatric population hospitalized in our center, compared to a framework of good practices based on data from the literature; to propose and implement improvement actions; and to compare non-compliance rate between the baseline and following the impact of improvement actions
Summary
On 1 January 2021, 20.7% of the French population was older than 65 years [1]. Several factors explain this increasing aging of the population, which will likely continue in the years to come. Iatrogenic accidents are two to three times more frequent after the age of 65 [4]; serious adverse events (SAEs) related to care represent 10% of hospitalizations for elderly subjects, and this rate rises to 20% for subjects over 80 years of age [5]. Thirty-nine percent of these SAEs are due to medication, and it is estimated that almost two-thirds are preventable iatrogenic events [5,6]. Preventing these events helps to limit potential alterations in an elderly subject’s condition and reduces hospitalizations [6]. Decreasing drug iatrogenesis involves, among other things, re-evaluating treatments and better prescription practices (“le mieux prescrire” in French), i.e., avoiding, as much as possible, prescribing potentially inappropriate medications to the elderly
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