Evaluation Of Potentially Inappropriate Medications In Elderly Inpatients In A 3A Hospital

Objective: In order to reduce the incidence of elderly inpatients potentially inappropriate medications,provide the basis for clinical rational drug use,and also provide reference for further improving the judgment standard of potentially inappropriate medications for the elderly in China through exploring possible impact factors and investigating the occurence of potentially inappropriaite medications in elderly inpatients in a 3A hospital.Methods:To evaluate 365 drug prescriptions of elderly inpatients aged 65 or older in a third-grade hospital from January to June of 2014 based on the beers criteria published in 2012,the beers criteria published in 2015,the STOPP/START criteria published in 2014 and the Chinese elderly potentially inappropriate medications criteria published in 2017 by clinical pharmacists,aimed at determining incidence and impact factors of potentially inappropriaite medications.Results: Based on the beers criteria published in 2012:189(51.78%)patients used no less than one potentially inappropriate medications.74 patients(20.27%)were treated with potential drug interactions.Chinese medicine injections were used in 273 patients(74.79%).Factors influencing potentially inappropriate medications were the number of drug combinations,length of hospital stay,age and Charlson Comorbidity Index scores.The incidence of potentially inappropriate medications in elderly patients was significantly correlated with the incidence of potential drug interactions and the usage rate of traditional Chinese medicine injection(P < 0.01).Based on the beers criteria published in 2015:232(63.56%)patients used no less than one potentially inappropriate medications.The elderly should avoid non-anti-infective drug interactions in 27 cases(7.40%).12 cases(3.29%)of non-anti-infective agents should be administered to the elderly based on renal function reduction/avoidance.The factors influencing the potentially inappropriate medications were the number of combined use and length of stay.Based on the STOPP criteria published in 2014:202 patients(55.34%)used no less than one potentially inappropriate medications.The highest detection rate of inappropriate prescription screening in the elderly was benzodiazepines(22.17%).Based on the START criteria published in 2014:256 patients(70.14%)had at least one prescription omissions.The top three prescription omissions detection rates in the elderly were 128 cases of statins(35.07%),111 cases of ACEI(30.41%)and 95 cases of antiplatelet agents(26.03%).The incidence of potentially inappropriate medications in elderly patients was significantly correlated with length of stay(P < 0.01).Based on the Chinese elderly potentially inappropriate medications criteria published in 2017:255(69.86%)patients used no less than one potentially inappropriate medications.The higher detection rate of potentially inappropriate medications were clopidogrel(32.88%),esazolam(18.63%)and clonidine(9.32%).The highest detection rate of potentially inappropriate medications was 104 cases(28.49%)of NSAIDs,46 cases(12.60%)of coagulation disorders or patients receiving anticoagulant treatment using clopidogrel and NSAIDs.The incidence of potentially inappropriate medications in elderly patients was significantly correlated with length of stay and age(P < 0.01),and was significantly correlated with the usage rate of traditional Chinese medicine injections(P < 0.05).Conclusion:Potentially inappropriate medications in elderly inpatients is the result of multiple factors,which should be fully controlled or utilized clinically to reduce the occurrence of drug-related problems.Clinical pharmacists should reference to all kinds of criteria so as to pay attention to clinical complications of elderly inpatients.Morever,clinical pharmacists should emphasize drug interactions and remind physicians and inpatients using traditional chinese medicine injections cautiously,aimed at decreasing drug risks of elderly inpatients and promoting reasonable drug use of elderly inpatients.