Quality Improvement: Examining Reduction of High Risk Medication Use in an Elderly Population

Purpose: The purpose of this project was to decrease the use of high-risk medications in adults age 65 and older. Polypharmacy is a potentially dangerous problem facing older patients in the United States; addressing high risk medication use is important to reduce risk. Methods: A questionnaire and educational handout regarding polypharmacy and high-risk medication were used to address the issue of high-risk medication use. Medication lists were reviewed for every patient meeting the criterion of being over the age of 65. Results: There was no significant reduction in high-rick medication use post-intervention. Those who were prescribed 1 high-risk medication (determined by the Beer's criteria) in the "prior to the enhancement implementation period" was 10.5% compared to the 10.0% of the same category in the "enhancement implementation" period. There was no change in either period for those prescribed 2 or more high-risk medications; these were both 0%. Conclusions: One of the reasons to explain the lack of significant reduction is there is not a large elderly patient population seen at the clinic. Also, a medication review function exists in the EMR that may have already led to a reduction in prescription of high-risk medications. While implementing use of the questionnaire and handout were appropriate, it was difficult to fully address the Beer's criteria extensive list of medications. The next step would be to have the EMR flag high-risk medications and identify those who are at higher risk of drug-drug interactions.