Implementation of Medication Reconciliation to Improve Medication Safety in a Geriatric Psychiatric Population

Abstract

Problem: There was a 90% prevalence rate of polypharmacy (5 or more prescribed daily medications) identified between January 2022, and May 2022, among geriatric adults aged sixty- five and older, on the inpatient geriatric unit a mental health hospital. Eleven percent of the geriatric inpatients experienced adverse drug reactions resulting in hyperglycemia with increased risk for type 2 diabetes. Twenty-two percent of the geriatric inpatients were sent to hospital emergency rooms secondary to adverse drug effects. The purpose of this Doctor of Nurse Practice (DNP) project was to implement the evidence-based Screening Tool for Older Persons/Screening Tool to Alert to Right Treatment (STOPP/START) for medication reconciliation to reduce polypharmacy and potential adverse drug reactions. Methods: The tool was applied to a sample size of eleven patients. Data collection was completed using two tools the STOPP/START Data Collection Tool and the STOPP/START Data Sheet. Weekly review of patient’s electronic medical administration record (EMAR) identified medications to be stopped or started. Data collection was completed over a 15-week period beginning August 2022. Results: There was an 11% decrease in the total number of prescribed medications post implementation. The total number of medications stopped was seventeen and the total number of medications started was five resulting in a net decrease of twelve medications among all patients over the 15-week implementation. The majority decreases were associated with antipsychotics, gastrointestinal and renal drug classes. Conclusion: STOPP/START tool is effective for identifying medications with potential adverse effects on the geriatric inpatient mental health setting.