External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland

Introduction. The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year. Material and methods. This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually. Results. Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable. Conclusions. Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic

Evaluation of potentially inappropriate prescribing and deprescription as elements of good medical practice in elderly patient care

The ongoing increase in the proportion of elderly people in society, sometimes referred to as the aging societies phenomenon, has numerous effects. Multimorbidity affects about every third person in the general population and, on average, the likelihood of chronic illness increases with age, so multimorbidity is more common in older age groups. This increases the demand for medication, leading to concurrent use of many drugs, which is referred to as polypharmacy. We carried out a literature review to identify the problems associated with the use of medications in people sixty years and older. Aging societies contain an increasing number of elderly people struggling with the burden of multimorbidity and the resulting polypharmacy. They require a systemic approach to prescription problems, which include potentially inappropriate medication (PIM) and overprescription, as well as potential prescribing omission (PPO), taking into account issues like lack of patient compliance and self-medication. Any attempt to solve these problems requires tools to objectively evaluate prescription practice, using the existing and emerging capabilities of electronic health records (EHR), actively encouraging all medical personnel who prescribe medications or evaluate their use (including physicians, nurses and pharmacists) to join rational deprescribing attempts, and convincing patients that more drugs are not always better