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Clinical pharmacy and clinical trials (including case series)
STOPP and START screening tools as supplements to the pharmaceutical medicines review
  1. M.G. Joergensen
  1. 1Region Zealand Hospital Pharmacy, Logistics and Clinical Pharmacy, Naestved, Denmark

Abstract

Background Inappropriate prescribing is a well-documented problem in older people. The screening tools STOPP (Screening Tool of Older Peoples' Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) have been formulated to identify potentially inappropriate medications (PIMs) and potential errors of omission (PEO) in older patients. Literature has shown that pharmacists can use STOPP and START reliably during their everyday practice to identify PIMs and PEOs in older patients.

Purpose To ensure high quality of the prescriptions for patients admitted to geriatric wards.

Materials and methods A clinical pharmacist used the STOPP and START criteria for each patient record of patients admitted to the geriatric ward. The screening tools were also presented to the physicians on the ward by the senior physician and all were given a pocket card with the criteria. The PIMs and PEOs were recorded as if identified by the pharmacist or by the physician. PIMs and PEOs identified by the pharmacist were presented to the physician for further action. The action taken on the PIMs and PEOs identified by the physician were also recorded.

Results In the period May to August 2011 151 patients were reviewed. PIMs were identified in 19% of the patients and most were due to overuse of proton pump inhibitors and long-term use of benzodiazepines. Seventeen percent had PEOs that were mostly related to the cardiovascular system; four identified by the pharmacist and accepted by the physician were due to lack of aspirin in the presence of chronic atrial fibrillation, where warfarin was contraindicated or due to lack of aspirin or clopidogrel in patients with coronary or cerebral disease.

Conclusions Using STOPP and START criteria as supplements to the medicines review the clinical pharmacist ensures high quality in the medicines prescribed for geriatric patients, a population for whom it is important to take precautions when prescribing.

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