Assessment of potentially inappropriate medications in orthogeriatric patients using the RASP list

Background and objective: Inappropriate drug prescribing can result
in over- and undertreatment. This is associated with adverse drugs
events. Both implicit and explicit screening methods can be used for
Int J Clin Pharm (2017) 39:208–341 305
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the detection of inappropriate prescribing. The objective of this study
was to investigate if the RASP list (Rationalization of home medication
by an Adjusted STOPP list in older Patients), an explicit
screening method adapted to the Belgian context, can be used to
reduce the number of potentially inappropriate medications (PIMs) in
orthogeriatric patients.
Setting and method: Single-centre, interventional study conducted at
the orthogeriatric department of the UZ Brussel, a 721-bed university
hospital. The RASP list was first applied by a last year pharmacy
student to the admission medication of orthogeriatric patients hospitalised
in October 2015. After potential adaptations to the medication
by a liaising geriatrician, the RASP list was additionally applied by
the same pharmacy student to the discharge medication of these
patients.
Main outcome measures: Detection and reduction of the number of
PIMs.
Results: In total, 59 orthogeriatric patients, from whom an informed
consent was obtained, participated in this study. On admission, a total
of 136 PIMs were detected in this population. At discharge, the
number of PIMs decreased to 101. The median number of PIMs per
patient decreased from 2 (on admission) to 1 (at discharge). This
difference was statistically significant (p\0.001; Wilcoxon Signed
Rank test). Drugs of ATC class N (nervous system) were responsible
for the highest number of PIMs.
Conclusion: PIMs can be detected and reduced in the hospital using
the RASP list. A structured and collaborative medication review
between (student) pharmacists and physicians appears a good
approach to reduce the number of potentially inadequate drugs.
Nevertheless, more research is necessary to substantiate this further as
well as to assess the clinical impact of the findings.