Inappropriate Prescribing in the Hospitalized Elderly Patient
The medication use process is a varied and complex progression of steps that begin with prescribing from a health care provider to communicating orders to a nurse or pharmacist, dispensing by a pharmacist, and administering either by a patient’s caregiver
- PDF / 105,876 Bytes
- 9 Pages / 504.567 x 720 pts Page_size
- 2 Downloads / 215 Views
Defining Inappropriate Prescribing in the Hospital Setting The medication use process is a varied and complex progression of steps that begin with prescribing from a health care provider to communicating orders to a nurse or pharmacist, dispensing by a pharmacist, and administering either by a patient’s caregiver or the patient (Institute of Medicine 1999; Page et al. 2010). Brook et al. noted that the appropriate use of a medication warrants that the potential benefit of the medication outweighs its potential risk (Brook et al. 1990). Therefore, appropriate evaluation of risk versus benefit at the point of prescribing is critical. The term potentially inappropriate prescribing encompasses when a medication’s use introduces a significant risk of an adverse drug event (ADE) when a potentially equal or more effective medication with a possibly lower-risk profile exists (Page et al. 2010; Gallagher et al. 2011). In addition, inappropriate prescribing includes situations where a clinically indicated
R.L. Page 2nd (*) Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Mail Stop C238, 12850 E Montview Blvd. V20-4125, Aurora, CO 80045, USA e-mail: [email protected] J.M. Ruscin Department of Internal Medicine, SIU School of Medicine, 701 N. 1st Street, Springfield, IL 62702, USA e-mail: [email protected]
medication is overused at a higher dose or frequency or for a longer duration than is indicated, underused based on agist or irrational reasons, omitted in the absence of a contraindication, or prescribed in combination with other medications with documented drug-drug or drug-disease interactions (Gallagher et al. 2011). The last description raises the concern that any prescribed medication may become a potentially inappropriate medication (PIM) when used in an inappropriate manner. When compared to younger adults, it is not surprising that inappropriate prescribing commonly occurs in older adults (e.g., 65 years of age) due to their higher prevalence of comorbidities, disability, medication burden, and dependency. A large number of studies have shown that PIM prescribing in this population occurs in the ambulatory setting, nursing home, and the emergency department (ED) leading to an increase in costly ADEs, hospitalizations, ED visits, as well as overall morbidity and mortality (Cahir et al. 2010; Dedhiya et al. 2010; Fick et al. 2008; Gallagher et al. 2011; Lund et al. 2010; Page et al. 2010). However, few data exist regarding potentially inappropriate prescribing in the inpatient setting and its impact on health outcomes. Presently, older adults account for over 35% of annual hospital admissions and are at higher risk for hospital readmission (Hanlon et al. 2004; Onder et al. 2003; Rothberg et al. 2008). In an analysis of fee-for-service Medicare beneficiaries, 19.6% of older adults who had been discharged from a hospital were
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_27, # Springer-Verlag Wien 2013
331
332
r
Data Loading...
