title: [Pharmacist rounds on geriatric wards : Assessment of 1 year of pharmaceutical counseling].
abstract: BACKGROUND
  Older patients suffer more often from drug-induced complications.
  
  
  OBJECTIVE
  What are the precise recommendations pharmacists can give to geriatricians?
  
  
  METHODS
  Two pharmacists conducted clinical rounds on 2 geriatric wards over a period of 54 weeks. Protocols of conspicuous medications for geriatric patients were analyzed and suggestions were made.
  
  
  RESULTS
  Particularly frequent were the questionable medical indications for proton pump inhibitors, allopurinol, pregabalin and gabapentin. Adjustment of the dosage of heparin and its analogs to impaired renal function of patients was often lacking. This was also occasionally the case for metformin, some antibiotics and simvastatin. There were several interactions of drug combinations with a high risk for QT prolongation. The inhibition of resorption of bisphosphonates and L‑thyroxin by the simultaneous intake of magnesium and calcium seemed to be probable. Furthermore, it was noticed that for some medications for patients treated by percutaneous endoscopic gastrostomy (PRG) administration by feeding tubes was not possible and combinations of different eye drops which should not be applied simultaneously but at delayed time intervals.
  
  
  CONCLUSIONS
  An additional medication-related visit provides an interventional option for avoidance of medication errors.
authors.affiliation: Katholisches Marienkrankenhaus gGmbH, Alfredstr. 9, 22087, Hamburg, Deutschland. roesler.geriatrie@marienkrankenhaus.org.
authors.forename: A
authors.initials: A
authors.lastname: Rösler
authors.affiliation: Antares Apotheke, Albert-Schweitzer-Ring 22, 22045, Hamburg, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Mißbach
authors.affiliation: Antares Apotheke, Albert-Schweitzer-Ring 22, 22045, Hamburg, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Kaatz
authors.affiliation: Katholisches Marienkrankenhaus gGmbH, Alfredstr. 9, 22087, Hamburg, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Kopf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D005853:Geriatrics; D005858:Germany; D006748:Hospital Departments; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D010595:Pharmacists; D012017:Referral and Consultation; D012307:Risk Factors; D056164:Teaching Rounds
keywords: Administration and dosage; Drug reaction; Drug-related side effects and adverse reactions; Inappropriate prescribing; Medication therapy management