[Pharmacist rounds on geriatric wards : Assessment of 1 year of pharmaceutical counseling].

BACKGROUND

Older patients suffer more often from drug-induced complications.

OBJECTIVE

What are the precise recommendations pharmacists can give to geriatricians?

MATERIAL AND METHODS

Two pharmacists conducted clinical rounds on 2 geriatric wards over a period of 54 weeks. Protocols of conspicuous medications for geriatric patients were analyzed and suggestions were made.

RESULTS

Particularly frequent were the questionable medical indications for proton pump inhibitors, allopurinol, pregabalin and gabapentin. Adjustment of the dosage of heparin and its analogs to impaired renal function of patients was often lacking. This was also occasionally the case for metformin, some antibiotics and simvastatin. There were several interactions of drug combinations with a high risk for QT prolongation. The inhibition of resorption of bisphosphonates and L‑thyroxin by the simultaneous intake of magnesium and calcium seemed to be probable. Furthermore, it was noticed that for some medications for patients treated by percutaneous endoscopic gastrostomy (PRG) administration by feeding tubes was not possible and combinations of different eye drops which should not be applied simultaneously but at delayed time intervals.

CONCLUSION

An additional medication-related visit provides an interventional option for avoidance of medication errors.