title: Application of the Beers Criteria to Alternate Level of Care Patients in Hospital Inpatient Units.
abstract: BACKGROUND
  The Beers criteria were developed to help in identifying potentially inappropriate medications (PIMs) for elderly patients. These medications are often associated with adverse events and limited effectiveness in older adults. Patients awaiting an alternate level of care (ALC patients) are those who no longer require acute care hospital services and are waiting for placement elsewhere. They are often elderly, have complex medication regimens, and are at high risk of adverse events. At the time of this study no studies had applied the Beers criteria to ALC patients in Canadian hospitals.
  
  
  OBJECTIVE
  To determine the proportion of ALC patients receiving PIMs and the proportion experiencing selected PIM-related adverse events.
  
  
  METHODS
  A retrospective chart review of ALC patients 65 years of age or older was performed to identify PIMs and the occurrence of selected adverse events (specifically central nervous system [CNS] events, falls, bradycardia, hypoglycemia, seizures, insomnia, gastrointestinal bleeding, and urinary tract infections). A logistic regression model with a random intercept for each patient was constructed to estimate odds ratios and probabilities of adverse events.
  
  
  RESULTS
  Fifty-two ALC patients were included in the study. Of these, 48 (92%) were taking a PIM. Of the 922 adverse events evaluated, 407 (44.1%) were associated with a regularly scheduled PIM. Among patients who were taking regularly scheduled PIMs, there was a significantly increased probability of an adverse CNS event and of a fall (p < 0.001 for both). The most common PIM medication classes were first-generation antihistamines (24 [46%] of the 52 patients), antipsychotics (21 patients [40%]), short-acting benzodiazepines (15 patients [29%]), and nonbenzodiazepine hypnotics (14 patients [27%]).
  
  
  CONCLUSIONS
  A high proportion of ALC patients were taking PIMs and experienced an adverse event that may have been related to these drugs. These findings suggest that the ALC population might benefit from regular medication review and monitoring to prevent or detect adverse events.
authors.affiliation: BScPharm, ACPR, was, at the time this study was conducted, a Pharmacy Resident at The Moncton Hospital, Moncton, New Brunswick. She is now a Clinical Pharmacist at the Janeway Children's Health and Rehabilitation Centre, Eastern Health, St John's, Newfoundland and Labrador.
authors.forename: Heather
authors.initials: H
authors.lastname: Slaney
authors.affiliation: BScPharm, PharmD, is Residency Coordinator and Pharmacy Clinical Practice Leader (Ambulatory Care), Horizon Health Network, The Moncton Hospital, Moncton, New Brunswick, and Adjunct Professor, College of Pharmacy, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Stacey
authors.initials: S
authors.lastname: MacAulay
authors.affiliation: , BSc(Pharm), PharmD, FCSHP, RPh, was, at the time this study was conducted, Clinical Manager and Clinical Pharmacy Specialist, Geriatrics, The Moncton Hospital, Moncton, New Brunswick.
authors.forename: Janice
authors.initials: J
authors.lastname: Irvine-Meek
authors.affiliation: MSc, is a Biostatistician with the Health Research Unit, Horizon NB, Horizon Health Network, The Moncton Hospital, Moncton, New Brunswick.
authors.forename: Joshua
authors.initials: J
authors.lastname: Murray
keywords: Beers criteria; Canad; adverse events; alternate level of care; retrospective