Assessment of Risk Associated with Medication-Related Problems in Elderly Outpatients

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Abstract

Background:

The Society of Hospital Pharmacists of Australia's (SHPA) Standards of Practice for Clinical Pharmacy provide a risk-classification system for interventions made by pharmacists in hospital inpatients. These standards are based on Australian standards for risk management, where risk is based on an estimate of the likelihood and consequences of an adverse outcome from a medication-related problem, if no intervention was made.

Aim:

To adapt and validate the SHPA risk-classification system for use in geriatric ambulatory care and to explore differences in classifications of risk made by pharmacists and geriatricians.

Method:

The SHPA risk-classification system was modified, piloted and reviewed by experts to assess face validity. 113 medication-related problems identified by an outpatient clinical pharmacist in aged care were independently classified by a senior clinical pharmacist, a geriatrician and the outpatient clinical pharmacist. When there was disagreement, the case was discussed and consensus reached. A random sample of 30 medication-related problems, stratified by consensus risk classification was classified by a second geriatrician.

Results:

Face validity of the adapted risk-classification system was established. Agreement between pharmacists on medication-related problem risk was moderate and agreement between pharmacists and geriatricians was fair. Risk of adverse outcomes was rated lower by geriatricians than pharmacists. Consensus was easily reached through case discussion.

Conclusion:

A system for classifying risk associated with pharmacist-identified medication-related problems in geriatric ambulatory care was developed. Differences were identified between pharmacists and geriatricians in the way medication-related risks are perceived. Classification of pharmacist-identified medication-related problems/interventions may need to be based on consensus between at least one doctor and pharmacist.

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