Patient Safety In Older Adults

Question 1

What is DIAE

Answer 1

Drug induced adverse events

Question 2

5 criteria used to identify DIAE

Answer 2

Drug Burden Index
Anticholinergic Scales
Beer's criteria
FORTA ( Fit for The Age)
STOPP ( screening tool of Older Person's Prescription) criteri

Question 3

The outcomes of Drug-induced adverse events are most commonly related to what?

Answer 3

MOA -mechanism of action

Question 4

Are the outcomes of drug induced adverse events well documented

Answer 4

May or may not be documented

Question 5

4 Factors that increase risk of drug induced adverse events

Answer 5

1- frailty
2- coexisting medical problems
3-memory issues
4-use of multiple-prescribed and non-prescribed MEDICATIONS

Question 6

2 limitations to identifying DIAE

Answer 6

1- incomplete medical records

• Thought process of DR. may not be in notes
• Medical records may be filed away

2-patients’ inability to describe issues
* patients complaints may NOT be documented or issues may lead to hospitalizations

Question 7

Best way to identify DIAE regarding patients involvement

Answer 7

A patient complaint AFTER starting a NEW medication

Question 8

Transition of care include what

Answer 8

1- Setting
2-Service
3-Practitioner
4-Level of care

Question 9

What is Medication reconciliation

Answer 9

Process of comparing a patient’s medication orders to ALL medications that a patient has been taking

Question 10

What is MR ROSS

Answer 10

Medication reconciliation- review of subject’s systems

Question 11

Prescribing cascade

Answer 11

Occurs when a new(chronic) drug is prescribed to treat the SYMPTOMS arising from an UNRECOGNIZED ADVERSE EVENT related to an EXISTING MEDICATION

Question 12

With prescribing cascade the unrecognized adverse event is thought to be WHAT to the patient and provider

Answer 12

1-The event is thought to due to NORMAL AGING

2-Misinterpreted as a NEW diagnosis common in older adults

Question 13

3 Factors which increases the risk for prescribing cascade

Answer 13

1- age
2-multiple co-morbid conditions
3-multiple drug therapies

Question 14

Broad spectrum antibiotics cause C. Difficile are treated with what 2 possible

Answer 14

Vancomycin

Metronidazole

Question 15

Acceptable prescribing cascade

Answer 15

Standard of care dictates the treatment of one medication with another medication to PREVENT NEGATIVE OUTCOMES

Example: furosemide ➡️ KCL

Question 16

Not quite prescribing cascade

Answer 16

Treatment of one medication adverse outcomes that require SHORT TERM TREATMENT and IF NOT harm may occur

Ex broad spectrum antibiotics requiring Vancomycin or Metronidazole

Question 17

What is used to determine a Prescribing cascade?

Answer 17

Bradford-Hill Criteria of Causation

Question 18

6 thing Bradford-Hill look at

Answer 18

1) Plausibility- DIAE/PC make sense based on MOA
2) Temporal( timing) Relationship- patient get initial medication and THEN comes DIAE/PC
3) Dose - Response Relationship- the HIGHER the dose the MORE DIAE/PC
4) Consistency- DIAE/ PC is confirmed in MULTIPLE previous trials
5) Consider ALTERNATIVE EXPLANATIONS - DIAE maybe due to another cause
6) EXPERIMENT- DIAE occurs after withdrawal and re-challenge

Question 19

What is PSSA

Answer 19

Prescription sequence symmetry analysis is a detection method for adverse drug events. It assess risk, temporality and consistency of ADE

Question 20

Cholinesterase inhibitors used to treat what and can cause what DIAE? This is an example of what in determining prescribing cascade?

Answer 20

Cholinesterase inhibitors used to treat Dementia , but can cause ⬆️urination.

If the ⬆️ urination is thought to be related to aging or progression of Dementia then DR may prescribe an anticholinergic medication WHICH CAN BLOCK POTENTIAL BENEFITS OF CHOLINESTERASE INHIBITORS AND CONTRIBUTE TO WORSENING DECLINE

An example of Retrospective Medication Claims Cohort Example