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7 Avoiding Harm andtheRole

oftheHealthcare Professional

7.1 Prescribing Culture

Organizational culture is complex, affects all the building blocks within the healthcare system, and can help or hinder the implementation of safe patient management and new innovation. It includes the values, assumptions, and beliefs held by those within the organization; more simply put, the way in which things are accepted to be done in practice [65, 66]. Results from the European Union (EU)-funded Stimulating Innovation Management of Polypharmacy and Adherence in the Elderly (SIMPATHY) Delphi study supported this understanding of organizational culture [67]. In fact, the failure to account for organizational culture is one of the main reasons cited when evaluating why planned change initiatives are unsuccessful. For example, an open patient safety culture is essential for discussions among health professionals reviewing and challenging prescribing appropriateness. Case study 3 illustrates challenges that are present for junior prescribers, which can include pharmacists and nurses as well as doctors, and particularly the pressure to prescribe medicines either out with their competence or what would be appropriate for the older person.

7.2 Factors toConsider toAddress theCulture andAvoid Medication-Related Harm

When considering prescribing within a team, there are several integral and interrelated elements that should be considered by all involved to ensure safe and effective patient care, as set out in Fig.20.4.

Using appropriate tools with reference to policies allows safety issues to be addressed in an understanding and accountable culture, empowering players to become role models for change among the team they work; this leads to improve-

ment of services while setting the standard for future care.

Tools for avoiding harm include guidance documents for reviewing treatment in older people taking multiple medications and addressing medication safety [30, 68] and also professional guidance on safe management of patients [69]. To ensure general robustness to avoid harm, there are common areas to be vigilant about when prescribing. These are presented in Fig.20.5, particularly considering management of pain for the older person particularly in the acute setting. It is worth noting that these areas are common areas of uncertainty in clinical practice and require attention to detail to ensure decisions are made in a patient’s best interest [70].

8 Education, Training,

andTools toGuide Prescribing

Medication-related harm is a major cause of hospital admissions and costs worldwide [50]. It is therefore essential that healthcare providers at different levels and specialities are empowered from the start of their training to become best practice prescribers. As detailed earlier, healthcare systems across the board are under immense pressures to cope with the ever-increasing clinical demand; more appropriate and safer prescribing would reduce adverse effects and therefore the burden on already stretched services. Figure 20.6 illustrates how vigilant prescribing can enhance patient safety and experience.

One aspect of minimizing medication-related harm in the older person can be through focused teaching and training of prescribers to prescribe and review appropriately with necessary input. This helps to create a culture that values the multifaceted aspects required for vigilant prescribing (Fig. 20.6). Although the focus of prescribing education tends to be on medical practitioners, other healthcare practitioners such as nurse practitioners and pharmacists also play a fundamental role and need to be exposed to equivalent training [71]. A “competent prescriber” is dened as a prescriber who embodies the four stages of the

Interactive

change

20 Safe Prescribing and Monitoring in the Older Person

Prescribing tools

Education

and improvement

For Patients and Carers

About medicines review

My medicines

Medicines A-Z

Questions for

my review

473

Review of Policies

Time Discussion

Decision

-making tools

Role model for

More Information

Whistle blowing

Fig. 20.4 Avoiding harm when prescribing: components required to avoid harm when prescribing in clinical practice for the multidisciplinary team (designed by Amil Mair)

prescribing process—information gathering, clinical decision-making, communication, and monitoring and review [72].

Royal Pharmaceutical Society of Great Britain [74], and national guidance on medicines optimization and review of medication [30, 75].

The International Union of Basic and Clinical Pharmacology’s international curriculum on geriatric clinical pharmacology for medical schools highlights key domains for knowledge, skills, and attitudes: (1) biology, physiology, and

8.1 Prescribing andtheMultidisciplinary Team

pathophysiology; (2) pharmacokinetics/pharmacodynamics; (3) communication; (4) quality use of medicines; (5) individualization of therapy; (6) polypharmacy and deprescribing; (7) adverse drug events and drug interactions; and (8) drug development, evaluation, and regulation [73].

In the UK, there is a competency framework

for all prescribers on prescribing that is led by the

Continued integration of pharmaceutical care training in various job roles, with tools and updates to implement current clinical guidance, enables consistent application of vigilant prescribing.

No clinician works or should ever try to work

in isolation. There has rightly been a shift from

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A. R. Mair et al.

ANALGESIA: Is there adequate pain relief (is

excess/ deficit exacerbating symptoms)? Can the

patient communicate that they have pain? Does

the patient use baseline analgesics? Are you using

known resources such as the WHO pain ladder?

OPTIMISING PRESCRIBING

SAFTEY FOR THE OLDER

PERSON

POLYPHARMACY AND MULTIMORBIDITY: Have

you considered the essentials (drug interactions,

drug toxicity, clearance, and comorbidities)? Do

you need specialist advice? Do new changes that

are implemented need to be relayed to usual

healhtcare provider?

DELIRIUM: Has the patient's baseline cognition been established? What prescribed medications may be contributing towards current patient presentation? Have you considered the reversible causes (infection,

pain, constipation, dehydration, emotional

distress, inappropriate polypharmacy)?

COMMUNICATION: Is the patient adherent with

prescribed medications? Will simple discussion

encourage adherence? Are carers / family aware

of medication plans? Is the healthcare team

aware of changes to medicines to ensure correct

dispensing? Does the patient's wider healthcare

team know about current medications?

Fig. 20.5 Optimizing prescribing safety for the older person: gure demonstrates how prescribing safety could be optimized for the older person with pain (designed by Amil Mair)

Empowered

prescriber

completing

regular

medication

review

Medical

optimisation of

patient

condition

Monitoring of

response to

treatment

Vigilant

prescribing

Reduction of

inappropiate

polypharmacy

& adverse drug

effects - 7 step

approach

Fig. 20.6 Steps in vigilant prescribing: illustrates how prescribers can optimize medication safety (designed by Amil Mair) (to be used alongside Fig.20.2: The seven-step process for appropriate polypharmacy)

Patient-centered

shared decision

making

20 Safe Prescribing and Monitoring in the Older Person

475

doctor-led hierarchy to one which recognizes and appreciates the skills and attributes of other highly skilled healthcare professionals. This shift has led to increased pharmacy team presence in primary and secondary care, as well as increased roles of allied healthcare professionals such as specialist diabetic nurses and specialist frailty nursing teams. This approach allows supplemental training and expertise to be brought to areas where prescribing is often overlooked or poorly understood. Discussing these in a multidisciplinary setting allows a 360°, holistic management of patient care and prescribing [69]. However, multiple prescribers bring additional risks around communication, responsibility, and care co-ordination, which need to be addressed proactively. Section 6 described multidisciplinary approaches that have been effective in addressing inappropriate prescribing for the older person.

8.2 Person-Centered DecisionMaking Tools

Provision and integration of person-centered decision-making tools into prescribing and clinical planning system that can be used by the healthcare team are essential. There already exists a variety of different tools such as the Scottish polypharmacy guidance [30], local healthcare trust guidance, national guidance [75] for medication prescribing, as well as internationally accredited clinical decision-making tools which incorporate patient comorbidities (such as the British Medical Journal Best Practice) [76]. Integrating these into the ever-evolving clinical documentation and prescribing systems with appropriate warnings for high-risk medications in computerized clinical decision support tools can reduce risks of unsafe prescriptions as well as guide to safest and most holistic management [69].

9 Summary andConclusions

The key points for consideration when prescribing for older people are set out in Table20.2.

Table 20.2 Key points for clinical practice to ensure medicationsafety and monitoring in the older person

• Aging increases multimorbidity and affectsmany aspects ofclinical pharmacology. Consequently, older people have a high prevalence of medication use and of medication-related harm

• Some medications are known to affect both cognitive and physical capacity in the older person and are considered modiable risk factors that can be addressed by undertaking a person-centered medication review, e.g., seven-step medication review

• When considering prescribing for the older person, consider pharmacokinetics and pharmacodynamics as these can be altered with aging

• In addition, when considering initiation of medication, considerthe benet to the older person using NumberNeeded toTreatand harm using NumberNeeded toHarm, and considering if they are applicable ensures treatmentwhich will benet the individual while minimizing harm.

• The level of frailty using available scales should be used to help informed decision-making on appropriates of prescribing

• Adverse effects of medications frequently present as nonspecic geriatric syndromes, such as falls, delirium, incontinence, or frailty

• In order to support the review of medication and prevent any medication-related harm, healthcare professionals should work with each other to address medication safety culture in the work place

• In clinical practice, pharmacovigilance is critical to prevent, detect, and manage medication-related harm

• Reporting of unexpected or severe adverse drug events seen clinically in older patients is important since postmarketing surveillance is a major source of information on medication effects in this population

• Tools to inform pharmacovigilance include prescribing tools to guide clinical medication reviews and quality indicators at a health service level. Safety indicators can be used to drive improvement

• Medication safety in older people requires constant review, good communication, and shared decisionmaking between all members of the clinical team in collaboration with the patient

This chapter has set out the contributing factors that predispose the older person to a higher risk of medication-related harm. These are multifactorial and include increasing multimorbidity with age and changes in physiology that affect pharmacodynamics and pharmacokinetics. Therefore, the importance of monitoring for effectiveness in clinical practice is discussed, highlighting some medicines commonly causing harm in the older person, including those that can

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contribute to falls, cognitive impairment, and/or frailty.

The importance of reviewing the dose of medicines and the effectiveness of medications for the older person needs to be considered. Personcentered approaches that allow for shared decision- making on prescribing and deprescribing with older patients are important. Multidisciplinary strategies for medication management are outlined, together with the education and training that is needed for healthcare professionals who prescribe and review treatment of the older person, including medication safety culture. The three case studies in the chapter provide practical and clinical application of key themes raised in this chapter.

A better evidence base is needed to guide safe and effective use of medicines in the older person, particularly for the older person with multimorbidity and frailty. Pharmacovigilance research is key to understanding real-world outcomes in this population. A key advance on the horizon is representative inclusion of patients in clinical drug development trials, so that efcacy and safety of drugs is rigorously evaluated in the frail older people who will use them so that the numbers needed to treat (NNT) can help assess whether the benets outweigh the risks. This evidence will inform robust clinical prescribing decisions with older people and improve quality use of medicines. Further research is also needed to understand the role of an individual’s goals and values of care in the context of being prescribed multiple medications.

10 Case Studies

10.1 Case Study 1: Multimorbidity,

Pain Management and Falls

A 78-year-old lady with multiple morbidities and medication-related harm

Mrs. M, a 78-year-old woman with type 2 diabetes and cardiovascular disease, presents with pain to her general practitioner(GP). Her blood pressure is well controlled and is 142/78mmHg and cholesterol is 4.8mmol/L.Recent urea and

electrolytes are within normal range, as are liver function tests. Latest glycated hemoglobin concentration (HbA1c) is 67mmol/mol (8.3%). This HbA1c level is within the target range agreed with Mrs. M.

Mrs. M presents at her most recent consultation with pain that the GP tells her is likely to be due to her diabetes and “nerve” pain. Mrs. M has previously tried codeine 30mg (up to four times a day) which helped a bit with pain but made her feel dizzy and constipated.

Medical history Current medications Type 2 diabetes

Cardiovascular disease Hypertension Hyperlipidemia Pain Insomnia

Simvastatin 40mgdaily Ramipril 10mg daily Aspirin 75mg daily Metformin 500mg three times a day Bisoprolol 5mg daily Amlodipine 5mg each morning Paracetamol when needed for pain

Her GP prescribes pregabalin, 75mg twice daily. Mrs. M is not keen to take these tablets, but reluctantly agrees. Mrs. M tells her family that the new medications make her feel dizzy. The family noties the GP, who says that she needs to take them for neuropathic pain and persevere.

Mrs. M has a fall. Her GP tells her that this is probably not due to the pregabalin. Mrs. M continues the pregabalin and has another fall. The GP stops the pregabalin.

Mrs. M doesn’t have any more falls. However, she loses condence, stops going outside, and becomes low in her mood.

Her GP discusses the option of adding an antidepressant. Mrs. M asks if they will make her dizzy and when her GP explains that they might, Mrs. M decides she wants to “see how she goes.”

Mrs. M continues to complain of pain and also presents with weakness in her legs.

On reviewing Mrs. M, medication-related events have more than likely to have been caused by the pregabalin and it’s important to review all her medications. The possible causes of harm and suggested actions are set out as follows:

1. What are the possible causes of harm in Mrs.

M? Mention the suggested action/s to minimize the harm in Mrs. M.

20 Safe Prescribing and Monitoring in the Older Person

477

If we consider Mrs. M, the things that are important to her are that she “doesn’t want to fall and her mood is low.” The fall happened after she started the pregabalin.

• While Mrs. M agreed to the trial of pregaba-

lin, when on monitoring it became clear that

it was causing unacceptable side effects; it

was appropriate to stop the medication.

• Review of appropriateness of the treatment

of her medicines for secondary prevention

of cardiovascular disease (which had been

prescribed for almost 15 years) found no

evidence of hypotension or postural hypo-

tension, indicating that these medicines

were unlikely to be contributing to her

falls. These are therefore appropriate to

continue for secondary prevention of car-

diovascular disease.

• After minimizing medication-related pre-

cipitants of her falls, consider referral to a

physiotherapist for strength and balance

training to reduce her risk of falling further

and so reduce her fear of falling.

10.2 Case Study 2: Addressing Anticholinergic and Sedative Burden

An 81-year-old man with high anticholinergic and sedativeburden

Mr. JL, 81 year old, lives with his wife at home. Recently diagnosed with Parkinson’s disease, his wife notices that he has been more forgetful and unsteady on his feet. He even tripped in the lounge room on the way to his chair. He has also been complaining of constipation.

Medical history Current medications Parkinson’s disease

Hypertension Hyperlipidemia Chronic back pain Insomnia Diabetes

Levodopa/carbidopa 100mg/25mg three times daily Telmisartan 80mg in the morning Rosuvastatin 10mg at night Tapentadol 50mg twice daily Temazepam 10mg at night Glibenclamide 5mg daily

His medications are packed into a dosing administration aid by the local pharmacy to improve adherence. Recent pathology tests reveal a high HbA1 of 9% (75mmol/mol). During the home visit, the consultant pharmacist discovers several missed doses of the lunchtime levodopa/ carbidopa. Mr. JL does not mention that he is in pain.

A review of Mr. JL’s medication would identify medication-related problems. These are set out as follows:

1. What are the medication-related problems

identied in Mr. JL through a person-centered medication review? Suggest suitable recommendations in resolving the identied medication-related problems in Mr. JL.

If we consider Mr. JL, “what’s important” to him and his wife is to address his issues: he is more forgetful, unsteady on his feet, and has bouts of constipation. Key medication-related problems may include:

• High anticholinergic and sedative burden

(tapentadol, temazepam in addition to

recently initiated levodopa/carbidopa) may

contribute to his forgetfulness and high

falls risk.

• Tapentadol possibly contributing to consti-

pation, and over prolonged period of time

lead to addiction, dependence, and

tolerance.

• Uncontrolled hyperglycemia and pre-

scribed glibenclamide, which should be

avoided when possible in older people due

to greater risk of hypoglycemia which can

lead to falls.

Recommendations:

• Aim to cease tapentadol. Taper down the

dose to avoid any withdrawal effects.

Introduce regular paracetamol and nonphar-

macological treatments (e.g., massage, heat

packs) to manage chronic back and osteoar-

thritic pain. Refer to a physiotherapist.

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• Aim to cease temazepam. Taper down the dose slowly to avoid any withdrawal effects. Educate on good sleep hygiene practices (e.g., avoiding caffeine, optimal sleep environment). If pharmacotherapy is needed, melatonin may be considered.

• Switch from glibenclamide to metformin for better glucose control. Sulfonylureas are not recommended in those over the age of 75 due to increased risk of hypoglycemia. Monitor for renal function before and after initiating metformin and adjust the dose accordingly. Ensure that the dose of metformin is increased gradually to minimize any gastrointestinal side effects. Repeat HbA1c in 3–6 months to assess impact on overall glucose control.

10.3 Case Study 3: AnEthical Dilemma

Ward round has just ended for the junior doctor on the surgical ward. Robert is a 79-year-old gentleman who has been admitted following a hip fracture. He has no cognitive past medical history and nursing staff are concerned that he is confused and “making too much noise,” disturbing the other patients. The senior nurse requests that a hypnotic is prescribed, albeit off license, so that nursing staff can work peacefully and other patients can rest. On informed reection, the junior doctor is concerned that a prescription of such a medication would not be appropriate and may cause medication-related harm if used. He appreciates the disruption that complex and challenging patients can have. Patient review reveals a gentleman who does not appear to be a risk to himself or others, and he suggests initially to attempt verbal de-escalation. The junior doctor discusses the case with an experienced hospital pharmacist and the medical registrar who agree with his assessment. There is concern that the patient is mildly delirious (acute) due to increased

pain from the fracture and possible constipation due to previous opioids. It is identied that a more effective, appropriate analgesic review could be useful. Tactful discussion and reference to guidance by the junior doctor with the member of staff who asked for the prescription do not end with a mutual agreement, albeit the decision to prescribe lies with the medical team. Later that day, he reects on this experience: he felt he made the right informed team decision, but will this staff member resent him or portray him in a negative light?

1. What are the factors to be considered during

such a challenging situation to ensure that you are functioning as a responsible and pharmacovigilant prescriber?

The use of prescribing tools, continued training and education,and working well within the multidisciplinary team are all integral aspects toward a healthcare professional’s practice. It is crucial that the prescribing healthcare professional is aware that ultimately they are responsible for their own practice and they need to ensure that it is robust.

A pharmacovigilant prescriber is one who does not work in isolation, taking into account the opinions and idea of others, and makes evidence- based decisions to ensure safe and effective patient care. They are not afraid to make difcult decisions and prioritize patient safety, making use of necessary support systems to make these challenging choices. There are several interlinked concepts for safe prescribing that need to function well, with each individual committed to being involved at every stage. Maintaining a smooth cycle (shown in Fig.20.4) reduces the risk of harm and means the healthcare professional is a proactive champion to bring positive change when required. This involves taking appropriate written and verbal advice as well as proactively raising areas of concern and improving systems through education and review [70].

20 Safe Prescribing and Monitoring in the Older Person

479

References

1. World Health Organization. 10 facts on ageing and health; 2022. https://www.who.int/news- room/

fact- sheets/detail/10- facts- on- ageing- and- health

2. Rechel B, Grundy E, Robine JM, Cylus J, Mackenbach JP, Knai C, McKee M. Ageing in the European union. Lancet. 2013;381(9874):1312–22. https://doi.

org/10.1016/S0140- 6736(12)62087- X.

3. World Health Organization. The world health report 2008 : primary health care now more than ever. Geneva: World Health Organization; 2008.

4. OECD. OECD health working paper no. 121, the economics of patient safety part III: long-term care;

2020. http://www.oecd.org/ofcialdocuments/pub

licdisplaydocumentpdf/?cote=DELSA/HEA/WD/ HWP(2020)6&docLanguage=En

5. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. https://doi.org/10.1016/

S0140- 6736(12)60240- 2.

6. Ornstein SM, Nietert PJ, Jenkins RG, Litvin CB.The prevalence of chronic diseases and multimorbidity in primary care practice: a PPRNet report. J Am Board Fam Med. 2013;26(5):518–24. https://doi.

org/10.3122/jabfm.2013.05.130012.

7. Boyd CM, Fortin M. Future of multimorbidity research: how should understanding of multimorbidity inform health system design? Public Health Rev. 2010;32(2):451–74. https://doi.org/10.1007/

BF03391611.

8. Wister A, Kendig H, Mitchell B, Fyffe I, Loh V. Multimorbidity, health and aging in Canada and Australia: a tale of two countries. BMC Geriatr. 2016;16(1):163. https://doi.org/10.1186/

s12877- 016- 0341- z.

9. Doos L, Roberts EO, Corp N, Kadam UT. Multidrug therapy in chronic condition multimorbidity: a systematic review. Fam Pract. 2014;31(6):654–63.

https://doi.org/10.1093/fampra/cmu056.

10. World Health Organization. Failure to take prescribed medicine for chronic diseases is a massive, worldwide problem. News; 2003.

11. Nguyen TL, Leguelinel-Blache G, Kinowski JM, Roux-Marson C, Rougier M, Spence J, etal. Improving medication safety: development and impact of a multivariate model-based strategy to target high-risk patients. PLoS One. 2017;12(2):e0171995. https://

doi.org/10.1371/journal.pone.0171995.

12. Picco L, Achilla E, Abdin E, Chong SA, Vaingankar JA, McCrone P, etal. Economic burden of multimorbidity among older adults: impact on healthcare and societal costs. BMC Health Serv Res. 2016;16:173.

https://doi.org/10.1186/s12913- 016- 1421- 7.

13. de Gruyter, W. (2012). Active ageing and solidarity between generations in Europe: rst results from SHARE after the economic crisis.

14. Ruellan AL, Bourneau-Martin D, Joyau C, Secher S, Fialaire P, Hitoto H, et al. Assessment of drug-drug interaction in an elderly human immunodeciency virus population: comparison of 3 expert databases. Br J Clin Pharmacol. 2021;87(3):1194–202. https://

doi.org/10.1111/bcp.14491.

15. Dumbreck S, Flynn A, Nairn M, Wilson M, Treweek S, Mercer SW, et al. Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines. BMJ. 2015;350:h949. https://doi.org/10.1136/bmj.h949.

16. Rawlins MD, Thompson JW.Pathogenesis of adverse drug reactions. In textbook of adverse drug reactions. Oxford: Oxford University Press; 1977.

17. Hilmer SN, Kirkpatrick CMJ. New horizons in the impact of frailty on pharmacokinetics: latest developments. Age Ageing. 2021;50(4):1054–63. https://doi.

org/10.1093/ageing/afab003.

18. Lim R, Ellett LMK, Semple S, Roughead EE. The extent of medication-related hospital admissions in Australia: a review from 1988 to 2021. Drug Saf. 2022;45(3):249–57. https://doi.org/10.1007/

s40264- 021- 01144- 1.

19. Elliott RA, Camacho E, Jankovic D, Sculpher MJ, Faria R. Economic analysis of the prevalence and clinical and economic burden of medication error in England. BMJ Qual Saf. 2021;30(2):96–105. https://

doi.org/10.1136/bmjqs- 2019- 010206.

20. Parekh N, Ali K, Page A, Roper T, Rajkumar C. Incidence of medication-related harm in older adults after hospital discharge: a systematic review. J Am Geriatr Soc. 2018;66(9):1812–22. https://doi.

org/10.1111/jgs.15419.

21. Lown I.Medication overload: America’s other drug problem: how the drive to prescribe is harming older adults; 2019. https://lowninstitute.org/wp- content/

uploads/2019/08/medication- overload- lown- web.pdf

22. Devik SA, Olsen RM, Fiskvik IL, Halbostad T, Lassen T, Kuzina N, Enmarker I.Variations in drugrelated problems detected by multidisciplinary teams in Norwegian nursing homes and home nursing care. Scand J Prim Health Care. 2018;36(3):291–9. https://

doi.org/10.1080/02813432.2018.1499581.

23. Kalisch LM, Caughey GE, Roughead EE, Gilbert AL. The prescribing cascade. Aust Prescr. 2011;34:162–6.

24. Morris EJ, Brown JD, Manini TM, Vouri SM. Differences in health-related quality of life among adults with a potential dihydropyridine calcium channel blocker-loop diuretic prescribing cascade. Drugs Aging. 2021;38(7):625–32. https://doi.

org/10.1007/s40266- 021- 00868- 0.

25. By the American Geriatrics Society Beers Criteria Update Expert, P. American Geriatrics Society 2019 updated AGS beers criteria(R) for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67(4):674–94. https://doi.org/10.1111/

jgs.15767.

26. O’Mahony D.STOPP/START criteria for potentially inappropriate medications/potential prescribing omis-

480

A. R. Mair et al.

sions in older people: origin and progress. Expert Rev Clin Pharmacol. 2020;13(1):15–22. https://doi.org/10

.1080/17512433.2020.1697676.

27. Lavan AH, O'Mahony D, Gallagher P, Fordham R, Flanagan E, Dahly D, etal. The effect of SENATOR (Software ENgine for the Assessment and optimisation of drug and non-drug Therapy in Older peRsons) on incident adverse drug reactions (ADRs) in an older hospital cohort - trial protocol. BMC Geriatr. 2019;19(1):40. https://doi.org/10.1186/

s12877- 019- 1047- 9.

28. Parekh N, Ali K, Davies JG, Rajkumar C.Do the 2015 beers criteria predict medication-related harm in older adults? Analysis from a multicentre prospective study in the United Kingdom. Pharmacoepidemiol Drug Saf. 2019;28(11):1464–9. https://doi.org/10.1002/

pds.4849.

29. Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to dene the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781–7. https://

doi.org/10.1001/archinte.167.8.781.

30. Scottish Government, editor. Polypharmacy guidance, realistic prescribing. 3rd ed. Scottish Government Polypharmacy Model of Care Group; 2018.

31. CDC.Community pharmacists and medication therapy management; 2021. https://www.cdc.gov/dhdsp/

pubs/guides/best- practices/pharmacist- mtm.htm

32. Doucette WR, McDonough RP, Klepser D, McCarthy R.Comprehensive medication therapy management: identifying and resolving drug-related issues in a community pharmacy. Clin Ther. 2005;27(7):1104–

11. https://doi.org/10.1016/s0149- 2918(05)00146- 3.

33. Chen TF. Pharmacist-led home medicines review and residential medication management review: the Australian model. Drugs Aging. 2016;33(3):199–204.

https://doi.org/10.1007/s40266- 016- 0357- 2.

34. Koria LG, Zaidi TS, Peterson G, Nishtala P, Hannah PJ, Castelino R. Impact of medication reviews on inappropriate prescribing in aged care. Curr Med Res Opin. 2018;34(5):833–8. https://doi.org/10.1080/030

07995.2018.1424624.

35. Lyles LF, Hildebrandt H, Mair A. Population health management approach: integration of communitybased pharmacists into integrated care systems: reections from the U.S., achievements in Scotland and discussions in Germany. Int J Integr Care. 2020;20(2):13. https://doi.org/10.5334/ijic.5431.

36. NHS. Structured medication reviews and the primary care network multidisciplinary approach;

2022. https://www.england.nhs.uk/gp/case- studies/

structured- medication- reviews- and- the- primary- carenetwork- multidisciplinary- approach/

37. Jansen J, Naganathan V, Carter SM, McLachlan AJ, Nickel B, Irwig L, etal. Too much medicine in older people? Deprescribing through shared decision making. BMJ. 2016;353:i2893. https://doi.org/10.1136/

bmj.i2893.

38. Sandbaek A, Moller MCR, Bro F, Hoj K, Due Christensen L, Mygind A.Involving patients in medi-

cines optimisation in general practice: a development study of the “PREparing patients for active involvement in medication review” (PREPAIR) tool. BMC Prim Care. 2022;23(1):122. https://doi.org/10.1186/

s12875- 022- 01733- 8.

39. Guthrie B, Payne K, Alderson P, McMurdo ME, Mercer SW. Adapting clinical guidelines to take account of multimorbidity. BMJ. 2012;345:e6341.

https://doi.org/10.1136/bmj.e6341.

40. Shippee ND, Shah ND, May CR, Mair FS, Montori VM. Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice. J Clin Epidemiol. 2012;65(10):1041–51. https://doi.org/10.1016/j.

jclinepi.2012.05.005.

41. Hodkinson A, Tyler N, Ashcroft DM, Keers RN, Khan K, Phipps D, etal. Preventable medication harm across health care settings: a systematic review and meta-analysis. BMC Med. 2020;18(1):313. https://

doi.org/10.1186/s12916- 020- 01774- 9.

42. Mair A, Wilson M, Dreischulte T. Addressing the challenge of polypharmacy. Annu Rev Pharmacol Toxicol. 2020;60:661–81. https://doi.org/10.1146/

annurev- pharmtox- 010919- 023508.

43. Fastbom J, Johnell K.National indicators for quality of drug therapy in older persons: the Swedish experience from the rst 10 years. Drugs Aging. 2015;32(3):189–

99. https://doi.org/10.1007/s40266- 015- 0242- 4.

44. Health Quality & Safety Commission New Zealand. Polypharmacy in people aged 65 and over;

2021. https://www.hqsc.govt.nz/assets/Our- data/

Publications- resources/Methodology_polyharmacy_2021.pdf

45. NSW Therapeutic Advisory, G.Resource kit for measuring strategies to reduce harm from polypharmacy in Australian Hospitals: QUM indicators, patient reported experience measures and risk stratication tools; 2020. https://www.nswtag.org.au/wp- content/

uploads/2020/11/Resource- Kit- for- MeasuringStrategies- to- Reduce- Harm- from- Polypharmacy_ Nov2020.pdf

46. Wu H, Kouladjian O’Donnell L, Fujita K, Masnoon N, Hilmer SN.Deprescribing in the older patient: a narrative review of challenges and solutions. Int J Gen Med. 2021;14:3793–807. https://doi.org/10.2147/

IJGM.S253177.

47. World Health Organization. Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity; 2017. https://

www.who.int/publications/i/item/9789241550109

48. Anandaciva S.What does the NHS England review of waiting times mean for accident and emergency departments?; 2019. https://www.kingsfund.org.

uk/publications/nhs- england- review- waiting- timesaccident- emergency

49. General Medical, C. Good practice in prescribing and managing medicines and devices; 2022. https://

www.gmc- uk.org/- /media/documents/prescribingguidance- updated- english- 20210405_pdf- 85260533. pdf

20 Safe Prescribing and Monitoring in the Older Person

481

50. World Health Organization. Global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care. Retrieved from Geneva World Health Organization; 2021.

51. Northern Cancer, A. Emergency Health Care Plan: Guide for Professionals; 2021. https://www.northern-

canceralliance.nhs.uk/wp- content/uploads/2021/05/ Professional- Guidance- EHCP- FINAL- April- 2021. pdf

52. RCEM.The Royal College of Emergency Medicine Best Practice Guideline: emergency department out of hours discharge medications; 2019. https://

rcem.ac.uk/wp- content/uploads/2021/10/RCEM_ Emergency_Department_Out_of_Hours_Discharge_ Medications_Final.pdf

53. Urtamo A, Jyvakorpi SK, Strandberg TE.Denitions of successful ageing: a brief review of a multidimensional concept. Acta Biomed. 2019;90(2):359–63.

https://doi.org/10.23750/abm.v90i2.8376.

54. Kennedy BK, Berger SL, Brunet A, Campisi J, Cuervo AM, Epel ES, et al. Geroscience: linking aging to chronic disease. Cell. 2014;159(4):709–13.

https://doi.org/10.1016/j.cell.2014.10.039.

55. López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G. The hallmarks of aging. Cell. 2013;153:1194–217. https://doi.org/10.1016/j.

cell.2013.05.039.

56. Hilmer SN, Gnjidic D, Abernethy DR. Pharmacoepidemiology in the postmarketing assessment of the safety and efcacy of drugs in older adults. J Gerontol A Biol Sci Med Sci. 2012;67(2):181–

8. https://doi.org/10.1093/gerona/glr066.

57. Campbell JM, Stephenson MD, de Courten B, Chapman I, Bellman SM, Aromataris E.Metformin use associated with reduced risk of dementia in patients with diabetes: a systematic review and meta- analysis. J Alzheimers Dis. 2018;65(4):1225–

36. https://doi.org/10.3233/JAD- 180263.

58. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A.A global clinical measure of tness and frailty in elderly people. CMAJ. 2005;173(5):489–95. https://doi.org/10.1503/

cmaj.050051.

59. Clegg A, Bates C, Young J, Ryan R, Nichols L, Teale EA, etal. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing. 2018;47(2):319.

https://doi.org/10.1093/ageing/afx001.

60. Gnjidic D, Bennett A, Le Couteur DG, Blyth FM, Cumming RG, Waite L, etal. Ischemic heart disease, prescription of optimal medical therapy and geriatric syndromes in community-dwelling older men: A population-based study. Int J Cardiol. 2015;192:49–55.

https://doi.org/10.1016/j.ijcard.2015.05.045. PMID:

25988541.

61. Bennett A, Gnjidic D, Gillett M, Carroll P, Matthews S, Johnell K, etal. Prevalence and impact of fallrisk increasing drugs, polypharmacy, and drugdrug interactions in robust versus frail hospitalised falls patients: a prospective cohort study. Drugs

Aging. 2014;31(3):225–32. https://doi.org/10.1007/

s40266-013-0151-3. PMID: 24452921.

62. Tannenbaum C, Paquette A, Hilmer S, Holroyd-Leduc J, Carnahan R.A systematic review of amnestic and non-amnestic mild cognitive impairment induced by anticholinergic, antihistamine, GABAergic and opioid drugs. Drugs Aging. 2012;29(8):639–58. https://

doi.org/10.2165/11633250- 000000000- 00000; doi:

10.1007/BF03262280.

63. Taylor-Rowan M, Edwards S, Noel-Storr AH, McCleery J, Myint PK, Soiza R, etal. Anticholinergic burden (prognostic factor) for prediction of dementia or cognitive decline in older adults with no known cognitive syndrome. Cochrane Database Syst Rev. 2021;5:CD013540. https://doi.

org/10.1002/14651858.CD013540.pub2.

64. Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc. 1999;47(7):850–3. https://doi.org/10.1111/j.1532-

5415.1999.tb03843.x.

65. Cameron KS, Quinn RE. Diagnosing and changing organizational culture. 3rd ed. John Wiley & Sons;

2011.

66. Deal TE, Kennedy AA. Corporate cultures: the rites and rituals of corporate life. NewYork: Cambridge Perseus; 2000.

67. Mair A, Fernandez-Llimos F, Alonso A, Harrison C, Hurding S, Kempen T, etal.. Polypharmacy management by 2030: a patient safety challenge; 2017. http://

www.simpathy.eu/sites/default/files/Managing_ polypharmacy2030- web.pdf.

68. Mair, A. Optimising patient care with Dr Amil Mair, North East England; 2021a. https://

bestpractice.bmj.com/info/customerstory/ optimising- patient- care- with- dr- amil- mair/

69. Mair A. World Health Organisation: Medication Safety in Polypharmacy Technical Report. Retrieved from Geneva, Switzerland; 2019. https://apps.who.

int/iris/rest/bitstreams/1235792/retrieve

70. Mair A. Safe best practice management of patients; 2021b. https://bestpractice.bmj.com/info/

safe- best- practice- management- of- patients

71. Kouladjian O’Donnell L, Sawan MJ. Deprescribing needs to be considered in the pharmacists' prescribing role. Med J Aust. 2020;212(3):141–141 e141. https://

doi.org/10.5694/mja2.50461.

72. Lum E, Mitchell C, Coombes I.The competent prescriber: 12 core competencies for safe prescribing. Aust Prescr. 2013;36:13–6.

73. Kashyap M, Thuermann P, Le Couteur DG, Abernethy DR, Hilmer SN. IUPHAR international geriatric clinical pharmacology curriculum for medical students. Pharmacol Res. 2019;141:611–5. https://doi.

org/10.1016/j.phrs.2019.01.032.

74. Royal Pharmaceutical, S. A competency framework for all prescribers; 2021. https://www.rpharms.

com/Portals/0/RPS%20document%20library/ Open%20access/Prescribing%20Competency%20

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