title: Minimizing anticholinergic drug prescribing in older hospitalized patients: a full audit cycle.
abstract: BACKGROUND
  Anticholinergic drugs are associated with poor outcomes in older patients but no specific intervention strategies aimed at reducing anticholinergic drug exposure have been described.
  
  
  OBJECTIVE
  To identify whether a consultant-led medication review targeting anticholinergics would reduce anticholinergic drug exposure [number of anticholinergic drugs and Anticholinergic Risk Scale (ARS) score].
  
  
  METHODS
  The first phase of the audit included 70 consecutive admissions (mean age 84 years, 53 women). ARS score was calculated on admission and after initial consultant review. Re-audit was undertaken on another 70 consecutive admissions (mean age 83 years, 43 women) after introducing a system of informing the responsible consultant of the ARS score at their first review.
  
  
  RESULTS
  Drugs with anticholinergic effects (n = 53) were prescribed preadmission to 45/140 (32%) of patients. Consultant geriatrician review reduced ARS scores (p = 0.01), especially following the introduction of the information system (p = 0.002). In the first arm of the audit, 51 (73%) patients had ARS of 0 after a consultant's review compared with 47 (67%) patients on admission, whilst 67 (96%) patients had ARS of 2 or less after a consultant's review compared with 63 (90%) patients on admission. In the second arm of the audit, 59 (84%) patients had ARS of 0 after a consultant's review compared with 48 (69%) patients on admission, whilst 70 (100%) patients had ARS of 2 or less after a consultant's review compared with 69 (99%) patients on admission. Anticholinergic drugs were either stopped, or their dose reduced, in 35% of patients in the first arm of the audit and in 73% of patients in the re-audit (odds ratio 5.0, 95% confidence interval 1.4-17.8).
  
  
  CONCLUSIONS
  Consultant-led medication review (standard practice) was effective at reducing anticholinergic drug exposure in the acute setting. A system of alerting clinicians to patients prescribed anticholinergic medications further reduced anticholinergic drug exposure.
authors.affiliation: Department of Medicine for the Elderly, Ward 102, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK.
authors.forename: Hui Sian
authors.initials: HS
authors.lastname: Tay
authors.affiliation: Department of Medicine for the Elderly, Aberdeen Royal Infirmary, NHS Grampian, and Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Roy L
authors.initials: RL
authors.lastname: Soiza
authors.affiliation: School of Medicine, University Flinders, Adelaide, South Australia.
authors.forename: Arduino A
authors.initials: AA
authors.lastname: Mangoni
keywords: anticholinergic drugs; deprescribing; drug withdrawal; elderly; prescribing
references.citation: Ther Adv Drug Saf. 2013 Dec;4(6):235-45
references.pmid: 25114784
references.citation: Expert Rev Clin Pharmacol. 2010 Jul;3(4):441-52
references.pmid: 22111675
references.citation: Arch Intern Med. 2008 Mar 10;168(5):508-13
references.pmid: 18332297
references.citation: J Clin Pharmacol. 2011 Feb;51(2):256-63
references.pmid: 20489026
references.citation: Arch Intern Med. 2007 Apr 23;167(8):781-7
references.pmid: 17452540
references.citation: Isr Med Assoc J. 2007 Jun;9(6):430-4
references.pmid: 17642388
references.citation: Ther Adv Drug Saf. 2011 Apr;2(2):37-43
references.pmid: 25083200
references.citation: Drugs Aging. 2009;26(8):677-86
references.pmid: 19685933
references.citation: Arch Intern Med. 2010 Oct 11;170(18):1648-54
references.pmid: 20937924
references.citation: J Am Med Dir Assoc. 2011 Oct;12(8):565-572
references.pmid: 21514242
references.citation: J Clin Pharmacol. 2012 Oct;52(10):1584-91
references.pmid: 22167569
references.citation: Br J Clin Pharmacol. 2004 Mar;57(3):231-6
references.pmid: 14998418
references.citation: J Am Geriatr Soc. 2011 Aug;59(8):1477-83
references.pmid: 21707557
references.citation: J Pharmacol Exp Ther. 2010 Apr;333(1):201-9
references.pmid: 20035022
references.citation: Ann Pharmacother. 2010 Nov;44(11):1725-32
references.pmid: 20876826
references.citation: Drugs Aging. 2008;25(12):1021-31
references.pmid: 19021301
references.citation: J Am Geriatr Soc. 2008 Dec;56(12):2203-10
references.pmid: 19093918
references.citation: Am J Geriatr Pharmacother. 2012 Aug;10(4):251-7
references.pmid: 22795433
references.citation: Hosp Pract (1995). 2011 Feb;39(1):30-6
references.pmid: 21441756
references.citation: Clin Pharmacol Ther. 2007 Feb;81(2):235-41
references.pmid: 17192773