Reactions 1362 - 30 Jul 20111. Morandi A, et al. Inappropriate medications in elderly ICU survivors: where toInappropriate prescribing common intervene? Archives of Internal Medicine 171: 1032-4, No. 11, 13 Jun 2011.

Available from: URL: http://dx.doi.org/10.1001/archinternmed.2011.233.in elderly2. Hamilton H, et al. Potentially Inappropriate Medications Defined by STOPP

Criteria and the Risk of Adverse Drug Events in Older Hospitalized Patients.There is a high prevalence of potentially inappropriate Archives of Internal Medicine 171: 1013-9, No. 11, 13 Jun 2011. Available

from: URL: http://dx.doi.org/10.1001/archinternmed.2011.215.medications (PIMs) and actually inappropriate3. Schnipper JL. Medication Safety: Are We There Yet?: Comment on "Potentiallymedications (AIMs) in elderly survivors of critical illness, Inappropriate Medications Defined by STOPP Criteria and the Risk of Adverse

suggest study findings by US researchers.1 The study Drug Events in Older Hospitalized Patients". Archives of Internal Medicine 171:1019-20, No. 11, 13 Jun 2011. Available from: URL: http://dx.doi.org/10.1001/defined PIMs using a modified version of the 2003 Beersarchinternmed.2011.220.criteria. 801085400

The study included 120 critically ill hospitalisedpatients aged ≥ 65 years . Of note, 66% of the patientswere prescribed ≥ 1 PIM before admission, and thisincreased to 85% of patients at discharge. Fifty percentof the PIMs at hospital discharge were first prescribed inthe ICU, whereas 20% were first prescribed on thehospital wards and 30% were prescribed beforeadmission. Of the 103 patients receiving ≥ 1 PIM atdischarge, 59% were receiving at least one AIM, and59% of the AIMs were first prescribed in the ICU,compared with 20% first prescribed on the hospitalwards and 21% prescribed before admission.

The researchers say that their study highlights theneed for greater vigilance of physicians in ICU andhospital wards regarding the appropriateness ofcontinuing medications started in the ICU. Theyconsider that incorporating an assessment ofmedication appropriateness when patients aredischarged or transferred out of the ICU "has thepotential to enhance patient safety".

Results of another study conducted in Ireland showthat avoidable ADRs in elderly patients which cause orcontribute to urgent hospitalisation are significantlyassociated with STOPP* criteria for potentiallyinappropriate medicines (PIMs), but not the 2003 Beerscriteria for PIMs.2 The researchers conclude that theSTOPP criteria are more clinically relevant than Beerscriteria for PIMs that result in ADRs.

The researchers prospectively studied 600 patientsaged ≥ 65 years hospitalised over a 4-month period. Atotal of 329 ADRs were identified in 158 (26.3%)patients, including 151 ADRs considered avoidable orpossibly avoidable and causal or contributory to hospitaladmission. Of these 151 ADRs, 94 (62.2%) were listed inSTOPP criteria, whereas only 34 (22.5%) were listed inBeers criteria (p < 0.001). The likelihood of a seriousavoidable ADR increased significantly when STOPPcriteria PIMs were prescribed (adjusted odds ratio 1.85;95% CI 1.51, 2.26), whereas Beers criteria PIMs did notsignificantly increase the risk of such ADRs (1.28; 0.95,1.72).

Dr Jeffrey Schnipper from the US says "the study isimportant because it facilitates the design of betterinterventions to improve medication safety amongambulatory elderly patients."3 However, he adds that notall STOPP criteria PIMs can be avoided, as sometimesthe benefits of a medication may outweigh the risks.Dr Schnipper says that more research is required toassess such interventions aimed at improvingmedication safety outcomes.* Screening Tool of Older Persons’ potentially inappropriatePrescriptions

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