• Pol. Arch. Med. Wewn. · Oct 2019

    Polypharmacy and medication errors on admission to palliative care.

    • Tomasz Grądalski.
    • St. Lazarus Hospice, Kraków, Poland. tomgr@mp.pl
    • Pol. Arch. Med. Wewn. 2019 Oct 30; 129 (10): 659-666.

    IntroductionMany patients at the end of their life are treated with multiple medications while some of the drugs may no longer be beneficial and should be reduced.ObjectivesThe aim of the study was to assess polypharmacy, overprescribing, and the incidence of presumable pharmacological errors at referral to palliative care.Patients And MethodsCurrent treatment in consecutive patients was analyzed based on the clinical judgment of a palliative care specialist on the first appointment. The number of drugs/tablets with pharmacotherapy inappropriateness was counted, analyzed, and a new therapy was proposed.ResultsA total of 337 patients were admitted. The median number of drugs / tablets used at referral was 7 / 9 per day. In patients with short life prognosis, the corresponding numbers were higher (8 / 10). Polypharmacy was found in 265 patients (78.6%) and at least 1 drug inappropriateness occurred in 238 patients (70.6%). The most frequent error type was lack of necessary concomitant drug. Patients who were bed‑bound (Palliative Performance Scale ≤40 points), with the shortest life expectancy (Gold Standards Framework, D), who died within 2 weeks or were discharged from the hospital and admitted to hospice had more often 1 or more potentially inappropriate medication. The risk of inappropriateness increased with the number of drugs / tablets prescribed by 13.3% / 7.4% per drug / tablet. The median number of drugs / tablets decreased on palliative consultation by 1.0 / 2.0 (P = 0.01 / P <0.001, respectively). Subgroups with a higher number of errors had a larger drug reduction.ConclusionsPolypharmacy and increased risk of drug inappropriateness particularly affect elderly patients referred by hospitals, with poor prognosis, low performance, admitted to in‑patient hospice. Therapy reduction may diminish the risk of therapeutic inappropriateness but requires further education within nonspecialist palliative care.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…