Giroux Audrey, Prudent Christelle, Jouanny Pierre, Muller Géraldine, Devilliers Hervé, Vadot Lucie
Pharmacy Department, Dijon University Hospital Center, 21000 Dijon, France.
Geriatric Internal Medicine Department, Dijon University Hospital Center, 21000 Dijon, France.
J Clin Med. 2021 Nov 16;10(22):5343. doi: 10.3390/jcm10225343.
Drug-related iatrogenesis is an important issue in the elderly population, and preventing iatrogenic accidents helps to reduce hospitalizations. Our study's objective was to evaluate prescriptions in the geriatric population of our establishment. The study conducted is a targeted clinical audit. Ten criteria were tested on the hospital prescriptions of people over 75 years old in 11 medical departments, before and after improvement actions. The non-compliance threshold was set at 10% of prescriptions for each criterion. In each phase, 165 patients were included. Four criteria were non-compliant (NC) in the first phase: the presence of Potentially Inappropriate Medications for the Elderly (PIMs) (NC = 57.6%), the adaptation of the medication to renal clearance (NC = 24.9%), the presence of illogical combination (NC = 9.7%), and the total anti-cholinergic score of the prescription (NC = 12.1%). After the implementation of improvement actions, the number of non-compliant criteria decreased between the two phases, from four to two. We obtained a significant improvement for three of the four criteria found to be non-compliant in the first phase. The criterion adaptation to renal function is close to compliance (NC = 10.1%) and the PIMs criterion remained non-compliant after reassessment (NC = 32.1%). Vigilance must be ongoing in order to limit drug iatrogeny, particularly in frail elderly patients.
药物相关的医源性疾病在老年人群中是一个重要问题,预防医源性事故有助于减少住院率。我们研究的目的是评估我院老年人群的处方情况。所开展的研究是一项针对性的临床审计。在采取改进措施前后,对11个医疗科室中75岁以上患者的医院处方测试了10项标准。每项标准的不合规阈值设定为处方的10%。在每个阶段,纳入了165名患者。在第一阶段,有四项标准不合规(NC):存在老年人潜在不适当用药(PIMs)(NC = 57.6%)、药物剂量根据肾脏清除率调整(NC = 24.9%)、存在不合理用药组合(NC = 9.7%)以及处方的总抗胆碱能评分(NC = 12.1%)。在实施改进措施后,两个阶段之间不合规标准的数量从四项减少到两项。我们发现第一阶段中四项不合规标准中的三项有显著改善。根据肾功能调整剂量这一标准接近合规(NC = 10.1%),而重新评估后PIMs标准仍不合规(NC = 32.1%)。必须持续保持警惕,以限制药物医源性疾病,特别是在体弱的老年患者中。