Pharmacist Intervention for Medication Safety in Elderly according to Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) Criteria

Purpose: Inappropriate prescribing (IP) are an important cause of hospitalization. There is a high risk of potential IP in elderly because of several characteristics, such as ageing and subsequent polypharmacy. Thus the aim of this study is to evaluate potential IP among elderly and set up a list of selected criteria based on STOPP criteria and generate the corresponding recommendations by pharmacists in Shuang-Ho Hospital.

Methods: A prospective study was conducted in Shuang-Ho Hospital between March 6 and April 24, 2012. All patients aged 65 years and over who admitted over three days were randomly recruited in this study. The prescriptions on the third day after admission were reviewed by pharmacists according to STOPP criteria. Then the pharmacists consulted with the physician and provided recommendations for the inappropriate prescription. The inappropriateness of each selected criterion and the acceptance of pharmacist’s intervention were recorded.

Results: Two hundred and ninety patients were included. The five criteria with highest inappropriateness were “Glibenclamide or chlorpropamide with type 2 diabetes mellitus” (50%), “Theophylline as monotherapy for chronic obstructive pulmonary disease (COPD)” (44 %), “Use of aspirin and warfarin in combination without histamine H₂receptor antagonist or proton pump inhibitor” (33%), “Tricyclic antidepressants with an opiate or calcium channel blocker” (29%) and “Non-cardioselective betablocker with COPD” (22%). The acceptance of pharmacist intervention was 80%. Finally, 13 criteria were selected and the corresponding recommendations were generated.

Conclusion: This study selected the criteria with high inappropriateness and acceptance of pharmacist intervention. They were provided for pharmacists to evaluate medication safety in elderly more efficiently. However, the selected criteria can not replace clinical judgment since it requires high-level clinical knowledge and experience. They can be implemented in more inpatients and need to be reassessed and updated on a routine basis.