3 research outputs found
Development of prescribing indicators for elderly medical inpatients
To identify and improve suboptimal prescribing for elderly patients we have developed a number of prescribing indicators which focus on areas of concern and allow evaluation of the benefit of interventions. We report here on fourteen indicators
Using prescribing indicators to measure the quality of prescribing to elderly medical in-patients
Objectives:âto evaluate the performance of hospitals using eight indicators designed to assess prescribing practice in medical inâpatients aged â„65 years.
Design:âlocal coalition teams were invited to collect crossâsectional prescribing and clinical data on 100 consecutive medical inâpatients aged â„65 years during a specific week in April 1999.
Setting:â102 hospitals across England.
Participants:âall NHS Trust hospitals in Wales and England were invited to participate in the study.
Main outcome measures:âthe performance and interâhospital variation of hospitals in eight indicators of prescribing. Also, the ageârelated appropriate use of antiâthrombotic stroke prophylaxis in atrial fibrillation, of aspirin in angina and of benzodiazepines.
Results:âdata were collected on 9,979 patients prescribed 70,458 medications. The number of hospitals achieving the prescribing goal for the indicators varied between 0 and 70. Frequency of administration instructions with âas requiredâ prescriptions were documented on 60% (10,403/17,258) of occasions. Generic (or acceptable proprietary) names were used for 84% (58,953/70,458) medications, 50% (4,870/9,778) of patients had documentation of allergy status on the drug chart and 23% (1,380/6,060) of patients had the potential risk of exceeding the maximum recommended dosage (4âg/24âh) of paracetamol. Longâacting hypoglycaemic drugs were prescribed to 50 patients. Antiâthrombotic stroke prophylaxis in atrial fibrillation were used appropriately for 53% (805/1,518) of patients, aspirin was used appropriately in angina for 90% (952/1,052) of patients and benzodiazepines were used appropriately for 49% (824/1,689) of patients. For the latter three indicators, the appropriate use of medications declined from 60% to 44%, 95% to 85% and 53% to 44% in patients aged â„85 years compared with those aged 65â74 years.
Conclusions:âprescribing indicators were effective in evaluating the performance of 102 hospitals on prescribing practice to medical inâpatients aged â„65 years. Prescribing to elderly medical inâpatients is subâoptimal but targets were achieved by some hospitals. This should inspire those hospitals not achieving high standards to improve their performance. The higher level of inappropriate prescribing with increasing age is unacceptable