scholarly journals Monitoring adverse events in older hospitalized patients: A retrospective cross-sectional study using validated screening criteria with administrative data

2018 ◽  
Vol 7 (5) ◽  
pp. 7
Author(s):  
Stacy A. Ackroyd-Stolarz ◽  
Susan K. Bowles ◽  
Lorri Giffin
Keyword(s):  
Administrative Data ◽  
Older Patients ◽  
Adverse Drug Events ◽  
Pressure Ulcers ◽  
Cross Sectional Study ◽  
System Level ◽  
Drug Event ◽  
Sectional Study ◽  
Cross Sectional ◽  
Screening Criteria

Objective: Older patients are at higher risk of experiencing an adverse event (AE) during an acute hospitalization. The objective of the current study was to use routinely collected administrative data to characterize AEs and their system-level impact for older patients hospitalized in one Canadian health authority.Methods: This retrospective cross-sectional study occurred in the Capital District Health Authority in Nova Scotia, Canada between April 1, 2012 and March 31, 2013. The primary outcome was identification of pressure ulcers, fall-related injuries and adverse drug events in patients 65 years of age and older admitted to an acute inpatient service. AEs were identified using validated screening criteria. Data were analyzed using standard descriptive statistics.Results: There were 11,747 hospitalizations during the study period. A total of 330 (2.8%) AEs in 325 patients were identified using the screening criteria. This included 55 (16.7% of 330) pressure ulcers, 25 (7.6%) fall-related injuries and 250 (75.8%) adverse drug events. The average length of stay was significantly higher in patients with a pressure ulcer (35.8 ± 47.3 vs. 9.0 ± 14.8 days, p < .0001), fall-related injury (30.3 ± 23.2 vs. 9.0 ± 15.2 days, p < .0001), or adverse drug event (14.6 ± 14.4 vs. 9.0 ± 15.2 days, p < .0001) during their acute hospitalization.Conclusions:Use of validated screening criteria with administrative hospitalization data provides important information for monitoring the system-level impact of common AEs in older patients. Significant and clinically important differences in healthcare utilization underscore the value in monitoring these AEs in this growing patient population.

scholarly journals Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e031483 ◽  
Author(s):  
Socheat Cheng ◽  
Tahreem Ghazal Siddiqui ◽  
Michael Gossop ◽  
Espen Saxhaug Kristoffersen ◽  
Christofer Lundqvist
Keyword(s):  
Pain Intensity ◽  
Older Patients ◽  
Adverse Drug Events ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medication Misuse ◽  
Factors Associated ◽  
Concurrent Use

ObjectivesTimely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics.DesignA prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.SettingSomatic departments of the Akershus University Hospital, Norway.Participants246 patients aged 65–90 were included.Outcome measuresProlonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients’ characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence.ResultsForty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75–84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88).ConclusionCNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs.Trial registration numberNCT03162081.

scholarly journals Prevalence and determinants of potentially inappropriate medication use in Hong Kong older patients: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e051527
Author(s):  
Huanyu Zhang ◽  
Eliza LY Wong ◽  
Samuel YS Wong ◽  
Patsy YK Chau ◽  
Benjamin HK Yip ◽  
...  
Keyword(s):  
Older Adults ◽  
Regression Analysis ◽  
Hong Kong ◽  
Older Patients ◽  
Inappropriate Medication ◽  
Cross Sectional Study ◽  
Potentially Inappropriate Medication ◽  
Multivariable Logistic Regression Analysis ◽  
Sectional Study ◽  
Cross Sectional

ObjectivesTo assess the prevalence of potentially inappropriate medication (PIM) use in Hong Kong older patients visiting general outpatient clinics (GOPCs) between 2006 and 2014 and to identify factors associated with PIM use among older adults visiting GOPCs in 2014.DesignCross-sectional study.SettingGOPC.ParticipantsTwo study samples were constructed including a total of 844 910 patients aged 65 and above from 2006 to 2014 and a cohort of 489 301 older patients in 2014.MeasurementsTwo subsets of the 2015 American Geriatrics Society Beers criteria—PIMs independent of diagnosis and PIMs due to drug–disease interactions—were used to estimate the prevalence of PIM use over 12 months. PIMs that were not included in the Hospital Authority drug formulary or with any specific restriction or exception in terms of indication, dose or therapy duration were excluded. Characteristics of PIM users and non-PIM users visiting GOPCs in 2014 were compared. Independent associations between patient variables and PIM use were assessed by stepwise multivariable logistic regression analysis.ResultsThe 12-month period prevalence of PIM use decreased from 55.56% (95% CI 55.39% to 55.72%) in 2006 to 47.51% (95% CI 47.37% to 47.65%) in 2014. In the multivariable regression analysis, the strongest factor associated with PIM use was the number of different drugs prescribed (adjusted OR, AOR 23.01, 95% CI 22.36 to 23.67). Being female (AOR 0.89, 95% CI 0.85 to 0.87 for males vs females) and having a greater number of GOPC visits (AOR 1.83, 95% CI 1.78 to 1.88) as well as more than six diagnoses (AOR 1.43, 95% CI 1.36 to 1.52) were associated with PIM use.ConclusionsThe overall prevalence of PIM use in older adults visiting GOPCs decreased from 2006 to 2014 in Hong Kong although the prevalence of PIM use was still high in 2014. Patients with female gender, a larger number of medications prescribed, more frequent visits to GOPCs, and more than six diagnoses were at higher risk for PIM use.

Improving Medication Safety Through the Use of Metrics

2013 ◽  
Vol 27 (1) ◽  
pp. 61-64
Author(s):  
Robert D. Beckett ◽  
Marina Yazdi ◽  
Laura J. Hanson ◽  
Ross W. Thompson
Keyword(s):  
Medication Errors ◽  
Medication Safety ◽  
Adverse Drug Events ◽  
Safety Information ◽  
Medication Use ◽  
Cross Sectional Study ◽  
Survey Instrument ◽  
Sectional Study ◽  
Cross Sectional ◽  
Safety Metrics

Purpose: Describe medication safety metrics used at University HealthSystem Consortium (UHC) institutions and recommend a meaningful way to report and communicate medication safety information across an organization. Methods: A cross-sectional study was conducted using an electronically distributed, open-ended survey instrument. Results: Twenty percent of the UHC institutions responded to our survey. Seventy-seven percent of those institutions responding to our survey reported their organization has defined metrics to measure medication safety; an additional 21% of the institutions were still in the process of defining metrics. Of metrics that were reported, 33% were true medication safety metrics. Results are distributed to a wide variety of institutional venues. Conclusion: Institutions should take several actions related to medication safety including defining local metrics; building metrics addressing preventable adverse drug events, medication errors, and technology; and reporting results to a variety of venues in order to design specific interventions to improve local medication use.

scholarly journals Influence of Education Level of Older Patients on Polypharmacy, Potentially Inappropriate Medications Listed in Beer’s Criteria, and Unplanned Hospitalization: A Cross-Sectional Study in Lahore, Pakistan

Medicina ◽  
2018 ◽  
Vol 54 (4) ◽  
pp. 57 ◽  
Author(s):  
Muhammad Sarwar ◽  
Sadia Iftikhar ◽  
Muhammad Sarfraz
Keyword(s):  
Older People ◽  
Older Patients ◽  
Formal Education ◽  
Cross Sectional Study ◽  
Education Level ◽  
P Value ◽  
Potentially Inappropriate Medications ◽  
Sectional Study ◽  
Cross Sectional ◽  
Inappropriate Medications

Objective: To evaluate influence of education level of older patients on polypharmacy, potentially inappropriate medications (PIMs) listed in Beer’s Criteria, and unplanned hospitalization. Methods: A cross-sectional study was conducted among older people aged ≥65 years between 1 December 2017 and 28 February 2018. For data analysis, descriptive statistics and logistic regression analysis were employed. Results: Among 385 older patients, 88.8% were prescribed PIMs and 56.4% underwent PIMs associated unplanned hospitalization. Older people were less exposed to polypharmacy or excessive polypharmacy as their education levels increased (no formal education vs. primary vs. secondary vs. tertiary, 74% vs. 69.8% vs. 60.5% vs. 58.1%). Patients having higher education were also accompanied by significantly lower prescription of PIMs (no formal education vs. primary vs. secondary vs. tertiary, 96% vs. 87.3% vs. 84.5% vs. 79.1%) as well as unplanned hospitalization (no formal education vs. primary vs. secondary vs. tertiary, 64.7% vs. 76.2% vs. 40.3% vs. 46.5%). Results of regression analysis revealed that no formal education (OR = 1.202, 95% CI = 1.032–2.146, p-value = 0.003) and primary education level (OR = 1.175, 95% CI = 1.014–1.538, p-value = 0.039) were significantly associated with the use of polypharmacy among older people. On the other hand, no formal education was significantly associated with the prescription of PIMs (OR = 1.898, 95% CI = 1.151–2.786, p-value = 0.007). Furthermore, older people with no formal education (OR = 1.402, 95% CI = 1.123–1.994, p-value = 0.010) and primary education level (OR = 1.775, 95% CI = 1.281–3.018, p-value = <0.001) were significantly more likely to undergo unplanned hospitalization. Conclusions: Patients having low literacy level are more likely to receive PIMs, polypharmacy, and undergo unplanned hospitalization in comparison to highly educated patients. Hence, promotion of health literacy for patients is crucial to overcome these problems.

Prevalence of pressure ulcers in hospitalised patients: a cross-sectional study

2020 ◽  
Vol 29 (Sup3) ◽  
pp. S20-S28
Author(s):  
Stella Olivo ◽  
Cristina Canova ◽  
Angela Peghetti ◽  
Maurilio Rossi ◽  
Renzo Zanotti
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Hospitalised Patients ◽  
Number Of Patients ◽  
Present On Admission

Objective: The main aim of this study was to estimate the prevalence of pressure ulcers (PU) and related risk factors of PU development in hospitalised patients in Italy. Furthermore, the study investigated the association between risk factors for PU present on admission and the development during hospitalisation (hospital-acquired pressure ulcer, HAPU). Methods: A cross-sectional study, using two separate designs at two separate timepoints: 2010 and 2015. The methodology used to measure PU prevalence was that recommended by the European Pressure Ulcer Advisory Panel (EPUAP). Results: The total sample was 7681 hospitalised patients (3011 patients in 2010, 4670 in 2015). Prevalence of PU in hospital was 19.5% in 2010 and 17% in 2015. The number of patients with PU present on admission were 9.60% in 2010 and 9.42% in 2015. Patients with HAPU were 5.08% in 2010 and 5.87% in 2015. Older age and comorbidities, and a total Braden score of ≤16 were positively associated with PU present on admission and HAPU in hospitals (p<0.05). A longer length of stay appeared to correlate positively with a better clinical outcome for PU if there were already present on admission. Heterogeneous results emerged for length of stay of >30 days and being admitted to intensive care unit (ICU). Conclusion: Our results are comparable with other European and Italian studies. Most of the risk factors associated with PU development have been confirmed. However, further studies are needed to examine the effects of context on PU present on arrival and HAPU, especially regarding hospital length of stay.

scholarly journals Potentially Inappropriate Medication Use in Older Hospitalized Patients with Type 2 Diabetes: A Cross-Sectional Study

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 219
Author(s):  
Rishabh Sharma ◽  
Manik Chhabra ◽  
Kota Vidyasagar ◽  
Muhammed Rashid ◽  
Daniela Fialova ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Patients ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Beers Criteria ◽  
Sectional Study ◽  
Older Population ◽  
Cross Sectional ◽  
Factors Associated

Background: Older patients with type 2 diabetes mellitus (T2DM) are at greater risk of receiving potentially inappropriate medications (PIM) during hospitalization which may result in adverse outcomes. Aim: To evaluate the extent of PIM use in the older population with T2DM during hospitalization in a tertiary care hospital in India. Methods: A cross-sectional study was carried out from August 2019 to January 2020 in a tertiary care teaching hospital among the older population (aged ≥ 65 years) hospitalized with T2DM. Medications prescribed during hospitalization were reviewed following Beers Criteria 2019 to identify the extent of polypharmacy and PIM use. Binary logistic regression was applied to determine the factors associated with PIM use. Results: The mean age of the 150 patients hospitalized with T2DM was 68.85 ± 5.51 years, most of whom were men (54.7%). The participants had at least four comorbidities and were receiving an average of nine medications per day; the median length of hospital stay was 8 days (interquartile range (IQR): 4–19 days). Overall, three quarters (74%) of the participants had at least one PIM prescribed during their hospitalization as per Beers Criteria. Significant factors associated with the use of PIM during hospitalization are patients taking a higher number of medications (odds ratio (OR): 7.85, 95% CI 1.49–41.10), lower creatinine clearance values (OR: 12.90, 95% CI 2.81–59.28) and female patients (OR: 2.29; 95% CI: 1.05–4.97). Conclusions: PIM use is frequently observed in older T2DM patients during hospitalization. Polypharmacy, reduced renal function and female gender are associated with higher PIM use. Engaging clinical pharmacists in evaluating medication appropriateness can improve the outcomes of older patients.

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