Year of Publication

2019

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. Alysia Adams

Committee Member

Dr. Melanie Hardin-Pierce

Abstract

Objective: The purpose of this project is to educate providers and implement the use of the Screening Tool of Older Persons’ Prescriptions (STOPP) on patients 65 and older admitted as inpatients at Owensboro Health and reduce potentially inappropriate medications (PIMs).

Background: Polypharmacy, the use of multiple medications or medications that are not medically necessary, is a persistent and growing problem for elderly patients in the United States. Polypharmacy has become synonymous with medications that are considered potentially inappropriate in individuals 65 or older. PIMs may be medications that, in the elderly, have deleterious effects, no indication, are used for treatment of the prescribing cascade, or medications that are continued beyond what is recommended or what is considered beneficial. Despite the extensive literature on the negative consequences of polypharmacy in the elderly population, the problem continues to grow. This problem continues because of the increased comorbid burden and prescribing cascade in the elderly. Determining effective interventions will be vital in ensuring the best outcomes for our aging population.

Aim: Implement an educational intervention using STOPP. Assess the educational affects and rates of potentially inappropriate medications in those who received the STOPP intervention compared with those who received usual care. Outcomes assessed the differences in potentially inappropriate medications based on the categories within the STOPP criteria in a control group and an intervention group.

Design: This was quasi-experimental, pre-post test design. Charts of 50 random patients meeting the inclusion criteria were assigned to a control group and charts of 50 random patients meeting inclusion criteria were assigned to an intervention group. Providers of patients in the intervention group received education on STOPP criteria. The number of potentially inappropriate medications from each category of STOPP criteria were measured at admission and at discharge in both groups.

Methods: The study was conducted at Owensboro Health a regional hospital in western Kentucky. The target sample included 100 random patients. Inclusion criteria were patients between the ages 65 and 85 years old, admitted as inpatient, and on 5 or more medications. Exclusion criteria were patients younger than 65 or older than 85, receiving palliative or hospice care, and trauma or critical care patients. Chart audits were done using STOPP v.2 at admission and discharge in the control and intervention groups.

Results:46 patients in the control group and 42 patients in the intervention group met all the requirements for the study. A p-value of

Conclusions: Results suggest that education on appropriate prescribing using STOPP as an intervention at the time of admission was successful in improving prescribing habits in elderly inpatients. This study suggests that using STOPP as an intervention was particularly successful in reducing PIMs in the specific categories: indication, gastrointestinal drugs, and cardiovascular drugs. Further research could incorporate strategies to expedite this process, including studies on implementation of STOPP criteria using computerized decision support software.

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