Polypharmacy and medication errors on palliative care admission

Abstract

Many patients at the end of their life are treated with multiple medications while some of the drugs may no longer be beneficial and should be reduced. The aim of the study was to assess polypharmacy, overprescribing, and the incidence of presumable pharmacological errors at referral to palliative care. Current treatment in consecutive patients was analyzed based on the clinical judgment of a palliative care specialist on the first appointment. The number of drugs/tablets with pharmacotherapy inappropriateness was counted, analyzed, and a new therapy was proposed. A total of 337 patients were admitted. The median number of drugs / tablets used at referral was 7 / 9 per day. In patients with short life prognosis, the corresponding numbers were higher (8 / 10). Polypharmacy was found in 265 patients (78.6%) and at least 1 drug inappropriateness occurred in 238 patients (70.6%). The most frequent error type was lack of necessary concomitant drug. Patients who were bed‑bound (Palliative Performance Scale ≤40 points), with the shortest life expectancy (Gold Standards Framework, D), who died within 2 weeks or were discharged from the hospital and admitted to hospice had more often 1 or more potentially inappropriate medication. The risk of inappropriateness increased with the number of drugs / tablets prescribed by 13.3% / 7.4% per drug / tablet. The median number of drugs / tablets decreased on palliative consultation by 1.0 / 2.0 (P = 0.01 / P <0.001, respectively). Subgroups with a higher number of errors had a larger drug reduction. Polypharmacy and increased risk of drug inappropriateness particularly affect elderly patients referred by hospitals, with poor prognosis, low performance, admitted to in‑patient hospice. Therapy reduction may diminish the risk of therapeutic inappropriateness but requires further education within nonspecialist palliative care.