Background Chronic use of psychoactive drugs can lead to many clinical adverse events (AE), especially in elderly populations due to the associated polypharmacy and their pathophysiological conditions.
Purpose To optimise psychoactive medications of polymedicated elderly psychiatric patients in an elderly healthcare centre, to achieve better efficiency and safety profiles.
Material and methods In an elderly psychiatric inpatient care unit from a 103 bed long term healthcare facility, a multidisciplinary adequacy programme of pharmacotherapy was implemented; the team was composed by pharmacists, geriatricians and a psychiatrist. The selection criteria (SC) included in the programme were based according to the psychoactive medication prescribed to the patients: SC-1: patients with ≥3 neuroleptic prescribed; SC-2: patients with ≥3 neuroleptic prescribed plus ≥1 hypnotic; SC-3: patients with ≥2 hypnotics prescribed; SC-4: patients with typical antipsychotics prescribed (not indicated in elderly patients). The patient’s pharmacotherapy was checked and discussed weekly following STOPP-START-2014 criteria over a period of 2 months, reducing the use of potentially inappropriate drugs and/or decreasing their dose. After patient inclusion, drug prescription changes and clinical evolution were registered.
Results Of 36 patients admitted to the psychiatric ward, 13 met the inclusion criteria (2 patients with SC-1, 6 patients with SC-2, 1 patient with SC-3 and 8 patients with SC-4; 4 patients met 2 SC). Following STOPP-START-2014 criteria, we implemented 40 changes in pharmacotherapy (>3 changes per patient): 24 drugs were stopped and 16 doses were modified (8 dose reductions, 5 ‘as needed’ prescription modifications and 3 exchanges to a suitable option). Only 4 interventions due to the changes implemented were needed: 1 increase in neuroleptic night dose and 3 cases of ‘as needed’ prescription (2 benzodiazepines for insomnia and 1 neuroleptic for agitation).
Conclusion A multidisciplinary adequacy programme was successfully implemented to optimise psychoactive pharmacotherapy prescriptions in elderly psychiatric patients. This implementation allowed deprescription and/or dose reduction of psychoactive drugs and, in consequence, decreased the risk of AE due to those medications.
References and/or acknowledgements Acknowledgement to the nursing team for implementing the changes from the programme and monitoring patients’ clinical evolutions.
No conflict of interest
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