title: Potentially inappropriate medications (PIMs) in older hospital in-patients: Prevalence, contribution to hospital admission and documentation of rationale for continuation.
abstract: OBJECTIVE
  To establish prevalence, sequelae and documentation of potentially inappropriate medication (PIM) use in older hospital in-patients.
  
  
  METHODS
  Notes of all patients ≥65 years old, admitted to our tertiary teaching hospital (January 2013), were retrospectively reviewed, and the Screening Tool of Older Persons' potentially inappropriate Prescriptions applied.
  
  
  RESULTS
  Amongst 534 patients, 54.8% (284) were on ≥1 PIM at admission, 26.8% on multiple; 60.8% were discharged on a PIM. Six percent of all admissions were potentially attributable to a PIM; falls associated with risk therapies were commonest (23/30), and often (65.2%) associated with serious injury. Pre-specified subgroup analysis (n = 100) identified 101 PIMs-at-discharge amongst 47 patients. In 82.2%, a clinical rationale for continued prescription was documented, with this communicated to the GP by letter in 71.1%.
  
  
  CONCLUSIONS
  PIMs were common, and contributed to admission and injury. Hospitalisation provides an opportunity for medication rationalisation, and documentation of rationale for any PIM use.
authors.affiliation: Department of Geriatric Medicine, St. Vincent's Hospital, Sydney, New South Wales, Australia.|Department of Geriatric Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: Danielle
authors.initials: D
authors.lastname: Ní Chróinín
authors.affiliation: School of Medicine, Federal University of Bahia, Bahia, Brazil.
authors.forename: Hugo M
authors.initials: HM
authors.lastname: Neto
authors.affiliation: Department of Geriatric Medicine, St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Diane
authors.initials: D
authors.lastname: Xiao
authors.affiliation: Department of Pharmacy, St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Anmol
authors.initials: A
authors.lastname: Sandhu
authors.affiliation: Department of Geriatric Medicine, St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Carly
authors.initials: C
authors.lastname: Brazel
authors.affiliation: Department of Geriatric Medicine, St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Nell
authors.initials: N
authors.lastname: Farnham
authors.affiliation: Department of Geriatric Medicine, St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Jacinta
authors.initials: J
authors.lastname: Perram
authors.affiliation: Department of Geriatric Medicine, St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Roach
authors.affiliation: Department of Geriatric Medicine, St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Sutherland
authors.affiliation: Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Sydney, New South Wales, Australia.|St Vincent's Clinical School, UNSW Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Ric
authors.initials: R
authors.lastname: Day
authors.affiliation: Department of Geriatric Medicine, St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Beveridge
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005568:Forms and Records Control; D006784:Hospitals, Teaching; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects*; D007297:Inpatients; D008297:Male; D008499:Medical Records; D059065:Medication Reconciliation; D009517:New South Wales / Q000453:epidemiology; D010343:Patient Admission; D010607:Pharmacy Service, Hospital; D019338:Polypharmacy; D000067561:Potentially Inappropriate Medication List; D015995:Prevalence; D011908:Rationalization; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
keywords: adverse drug event; drug prescription; inappropriate prescription; polypharmacy