Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study
Keywords:
Aged, Inappropriate prescribing, Intensive care units, Potentially inappropriate medication list, Potentially inappropriate medications, Older adults, Beers criteria, ICU intensive care unitsAbstract
BACKGROUND: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use.
OBJECTIVE: To estimate the incidence and factors associated with PIMs use in intensive care units.
DESIGN AND SETTING: Historical cohort study was conducted in a high-complexity hospital in Brazil.
METHODS: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a “Patient Safety Project” database. A Chi-square test, Student’s t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%.
RESULTS: According to Beers’ criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43).
CONCLUSIONS: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.
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References
Renom-Guiteras A, Meyer G, Thürmann PA. The EU(7)-PIM list: A list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015;71(7):861-
PMID: 25967540; http://doi.org/10.1007/s00228-015-1860-9.
Plácido AI, Aguiar A, Piñeiro-Lamas M, et al. Assessment of potentially inappropriate medications using the EU (7)-PIM list, in a sample of Portuguese older adults’ residents in nursing homes. Risk Manag Healthc Policy. 2022;15:1343-52. PMID: 35860675; http://doi.org/10.2147/RMHP. S346300.
Al-Azayzih A, Alamoori R, Altawalbeh SM. Potentially inappropriate medications prescribing according to beers criteria among elderly outpatients in jordan: A cross sectional study. Pharm Pract. 2019;17(2):1439. PMID: 31275497; http://doi.org/10.18549/ PharmPract.2019.2.1439.
Alhawassi TM, Alatawi W, Alwhaibi M. Prevalence of potentially inappropriate medications use among older adults and risk factors using the 2015 American Geriatrics Society Beers criteria. BMC Geriatr. 2019;19(1):154. PMID:31142286; http://doi.org/10.1186/s12877-019-1168-1.
Jungo KT, Streit S, Lauffenburger JC. Utilization and spending on potentially inappropriate medications by US older adults with multiple chronic conditions using multiple medications. Arch Gerontol Geriatr. 2021;93:104326. PMID: 33516154; http://doi.org/10.1016/j.archger.2020.104326.
Brkic J, Fialova D, Okuyan B, et al. Prevalence of potentially inappropriate prescribing in older adults in Central and Eastern Europe: a systematic review and synthesis without meta-analysis. Sci Rep. 2022;12(1):16774. PMID: 36202826; http://doi.org/10.1038/s41598-022-19860-8.
Mekonnen AB, Redley B, Courten B, Manias E. Potentially inappropriate prescribing and its associations with health-related and system-related outcomes in hospitalised older adults: A systematic review and metaanalysis. Br J Clin Pharmacol. 2021;87(11):4150-72. PMID: 34008195; http://doi.org/10.1111/bcp.14870.
Hyttinen V, Jyrkkä J, Valtonen H. A Systematic review of the impact of potentially inappropriate medication on health care utilization and costs among older adults. Med Care. 2016;54(10):950-64. PMID: 27367864; http://doi.org/10.1097/MLR.0000000000000587.
Spinewine A, Schmader KE, Barber N, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370(9582):173-84. PMID: 17630041; http://doi.org/10.1016/S01406736(07)61091-5.
Hanna V, Chahine B, Al Souheil F. Under-prescription of medications in older adults according to START criteria: A cross-sectional study in Lebanon. Heal Sci Reports. 2022;5(5):e759. PMID: 35949679; http://doi.org/10.1002/hsr2.759.
Candeias C, Gama J, Rodrigues M, Falcão A, Alves G. Potentially inappropriate medications and potential prescribing omissions in elderly patients receiving post-acute and long-term care: application of screening tool of older people’s prescriptions/screening tool to alert to right treatment criteria. Front Pharmacol. 2021;12:747523. PMID: 34737705; http://doi.org/10.3389/fphar.2021.747523.
Motter FR, Fritzen JS, Hilmer SN, Paniz EV, Paniz VMV. Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria. Eur J Clin Pharmacol. 2018;74:679-700. PMID: 29589066; http://doi.org/10.1007/s00228-018-2446-0
Alshammari H, Al-Saeed E, Ahmed Z, Aslanpour Z. Reviewing potentially inappropriate medication in hospitalized patients over 65 using explicit criteria: a systematic literature review. Drug Healthc Patient Saf. 2021;13:183-210. PMID: 34764701; http://doi.org/10.2147/DHPS.S303101
Weston C, Weston J. Applying the Beers and STOPP Criteria to care of the critically ill older adult. Critical Care Nursing Quarterly. 2015; 38(3):231-6. PMID: 26039644; http://doi.org/10.1097/CNQ.0000000000000077.
Sugii N, Fujimori H, Sato N, Matsumura A. Regular medications prescribed to elderly neurosurgical inpatients and the impact of hospitalization on potentially inappropriate medications. J Rural Med. 2018;13(2):97-104. PMID: 30546797; http://doi.org/10.2185/jrm.2964.
Chivapricha W, Srinonprasert V, Suansanae T. Impact of geriatric pharmacy specialist interventions to reduce potentially inappropriate medication among hospitalized elderly patients at medical wards: a prospective quasi-experimental study. Drugs Real World Outcomes. 2021;8(1):39-47. PMID: 33063296; http://doi.org/10.1007/s40801-020-00214-7.
Kersten H, Hvidsten LT, Gløersen G, Wyller TB, Wang-Hansen MS. Clinical impact of potentially inappropriate medications during hospitalization of acutely ill older patients with multimorbidity. Scand J Prim Health Care. 2015;33(4):243-51. PMID: 26553225; http://doi.org/10.3109/028 13432.2015.1084766.
von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495-9. PMID: 25046131; http://doi.org/10.1016/j.ijsu.2014.07.013.
Padilha KG, Barbosa RL, Oliveira EM, et al. Patient safety in intensive care units: Development of a research project. Rev Esc Enferm. 2015;49(spe):154-60. PMID: 26761706; http://doi.org/10.1590/S0080623420150000700022.
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957-63. Erratum in: Dale V. Increasing oxygen delivery in surgical patients. JAMA. 1994;271(17):1321. PMID: 8254858; https://doi.org/10.1001/jama.270.24.2957.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40(5):373-83. PMID: 3558716; http:// doi.org/10.1016/0021-9681(87)90171-8.
Le Gall JR, Klar J, Lemeshow S, et al. The logistic organ dysfunction system: A new way to assess organ dysfunction in the intensive care unit. JAMA. 1996;276(10):802-10. PMID: 8769590; http://doi.org/10.1001/jama.276.10.802.
Vetrano DL, Landi F, De Buyser SL, et al. Predictors of length of hospital stay among older adults admitted to acute care wards: A multicentre observational study. Eur J Intern Med. 2014;25(1):56-62. PMID: 24054859; http://doi.org/10.1016/j.ejim.2013.08.709.
Drug Interaction Checker [base de dados]. Medscape; 2015. Available from: https://reference.medscape.com/drug-interactionchecker. Accessed in 2023 (Jan 20).
American Geriatrics Society Beers Criteria. American Geriatrics Society 2019 Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674-94. PMID: 30693946; http://doi.org/10.1111/jgs.15767.
Kerliu L, Citaku D, Rudhani I, et al. Exploring instruments used to evaluate potentially inappropriate medication use in hospitalised elderly patients in Kosovo. Eur J Hosp Pharm. 2021;28(4):223-8. PMID: 34162674; http:// doi.org/10.1136/ejhpharm-2019-001904.
Fialová D, Laffon B, Marinković V, et al. Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies). Eur J Clin Pharmacol. 2019;75(4):451-
PMID: 30610276; http://doi.org/10.1007/s00228-018-2603-5.
Poudel A, Peel NM, Nissen L, et al. Potentially inappropriate prescribing in older patients discharged from acute care hospitals to residential aged care facilities. Ann Pharmacother. 2014;48(11):1425-33. PMID: 25159001; http://doi.org/10.1177/1060028014548568.
Fabbietti P, Di Stefano G, Moresi R, et al. Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital: a prospective study. Aging Clin Exp Res. 2018;30(8):977-84. PMID: 29128999; http:// doi.org/10.1007/s40520-017-0856-y.
Hu B, Ye H, Sun C, et al. Metoclopramide or domperidone improves post-pyloric placement of spiral nasojejunal tubes in critically ill patients: A prospective, multicenter, open-label, randomized, controlled clinical trial. Crit Care. 2015;19(1):61. PMID: 25880172; http://doi.org/10.1186/ s13054-015-0784-1.
Ladopoulos T, Giannaki M, Alexopoulou C, et al. Gastrointestinal dysmotility in critically ill patients. Ann Gastroenterol. 2018;31(3):273-
PMID: 29720852; http://doi.org/10.20524/aog.2018.0250.
Olariu E, Pooley N, Danel A, Miret M, Preiser JC. A systematic scoping review on the consequences of stress-related hyperglycaemia. PLoS One. 2018;13(4):e0194952. PMID: 29624594; http://doi.org/10.1371/ journal.pone.0194952.
Kaddoum R, Khalili A, Shebbo FM, et al. Automated versus conventional perioperative glycemic control in adult diabetic patients undergoing open heart surgery. BMC Anesthesiol. 2022;22(1):184. PMID: 35710339; http://doi.org/10.1186/s12871-022-01721-6.
Lou R, Jiang L, Zhu B. Effect of glycemic gap upon mortality in critically ill patients with diabetes. J Diabetes Investig. 2021;12(12):2212-20. PMID: 34075715; http://doi.org/10.1111/jdi.13606.
Seo Y, Lee HJ, Ha EJ, Ha TS. 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit. Acute Crit Care. 2022;37(1):1-25. PMID: 35279975; http://doi.org/10.4266/ACC.2022.00094.
Fraser GL, Devlin JW, Worby CP, et al. Benzodiazepine versus nonbenzodiazepine-based sedation for mechanically ventilated, critically ill adults: A systematic review and meta-analysis of randomized trials. Crit Care Med. 2013;41(9):S30-S38. PMID: 23989093; https://doi. org/10.1097/ccm.0b013e3182a16898.
Aoki Y, Kato H, Fujimura N, et al. Effects of fentanyl administration in mechanically ventilated patients in the intensive care unit: a systematic review and meta-analysis. BMC Anesthesiol. 2022;22(1):323. PMID: 36271330; http://doi.org/10.1186/s12871-022-01871-7.
Patel RP, Gambrell M, Speroff T, et al. Delirium and sedation in the intensive care unit: Survey of behaviors and attitudes of 1384 healthcare professionals. Crit Care Med. 2009;37(3):825-32. PMID: 19237884; http:// doi.org/10.1097/CCM.0b013e31819b8608.
Al-Qadheeb NS, Hashhoush MS, Maghrabi K, et al. Point prevalence of delirium among critically ill patients in Saudi Arabia: A multicenter study. Saudi Crit Care J. 2020;4(1):9-11. http://doi.org/10.4103/sccj. sccj_7_20.
Arbabi M, Ziaei E, Amini B, et al. Delirium risk factors in hospitalized patient: a comprehensive evaluation of underlying diseases and medications in different wards of a large Urban Hospital Center in Iran. BMC Anesthesiol. 2022;22:147. PMID: 35578181; http://doi.org/10.1186/ s12871-022-01690-w.
Zhou T, Liu P, Dhruva SS, et al. Assessment of hypothetical out-of-pocket costs of guideline-recommended medications for the treatment of older adults with multiple chronic conditions, 2009 and 2019. JAMA Intern Med. 2022;182(2):185-95. PMID: 34982097; http://doi.org/10.1001/ jamainternmed.2021.7457.
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