5USE OF START/STOPP CRITERIA AS TOOLS TO DETERMINE AREAS FOR IMPROVEMENT IN PRESCRIBING IN A BELFAST ACUTE CARE OF THE ELDERLY UNIT

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Abstract

Introduction: Older people often have multiple morbidities and often are prescribed multiple medications. They have increased likelihood of drug–drug interactions, drug–disease interactions and adverse drug events [Mangoni and Jackson (2003, Br J Clin Pharmacol, 57, 6–14; Juurlink, Mamdami, Kopp et al. (2003, JAMA, 289, 1652)]. Medications review is a central tenet of the ‘Silver book’ and comprehensive geriatric assessment [Ellis, Whitehead, Robinson (2011, BMJ, 2011; 343, d6553)]. The START tool can identify potentially inappropriate medications (PIMs) and a STOPP tool can identify potential prescribing omissions (PPOs). Inter-rater reliability is good.

Sampling methods: Before using the START/STOPP tools in all elderly care ward inpatients in Belfast City Hospital (BCH), a pilot audit loop was undertaken in the rehabilitation ward on 18 August 2011. A doctor collected data from medicines reconciliation forms on prescribing at the time of admission and compared with prescribing on the day of the data collection. Data collection was undertaken on 29 March 2012.

Results: On admission, 19 PIMs were identified and contributed to admission on 10 occasions. Fifteen PPOs were identified. Ten patients had one PIM, eight patients had two and one patient had three. Eleven patients had one PPO and four with two.

On the day of audit, eight patients had one PIM and two had two, representing a reduction. PPOs were reduced to one patient with one and three with two.

Conclusions: START/STOPP tools are generalisable to patient population in Belfast. In the BCH unit, PIMs and PPOs were being identified and addressed without formal use of START/STOPP tools in medication reviews or medicines reconciliation. Most frequent PIMs and PPOs in the unit were identified to the team.

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