Background: Inappropriate polypharmacy is dangerous and disproportionately affects older adults, causing 1.3 million emergency departments within the United States every year. Formal medication reviews have been shown to reduce the prevalence and severity of this problem. An assisted living facility has no formal process to review residents’ medication lists for appropriateness. Each resident takes an average of 5.2 medications and qualitative interviews suggest some prescriptions are inappropriate.

Objective: The purpose of this quality improvement project was to improve providers prescribing behavior by formally reviewing assisted living residents’ medication lists for appropriateness.

Methods: This quality improvement project included 24 residents in a single assisted living setting. Two healthcare providers were exposed to training related to use of the screening tool of older persons’ prescriptions (STOPP). The medication appropriateness review tool and medication appropriateness review checklist were created from the STOPP criteria. These paper tools aided providers with their medication reviews and allowed for data collection. Outcomes included the proportion of assisted living residents who received a medication review and evidence of inappropriate prescriptions. A descriptive analysis was performed using Microsoft Excel.

Results: All 24 assisted living residents’ medications were formally reviewed using the STOPP criteria. Reviews required an average of 7.65 minutes to complete and providers did not feel that the process was overly burdensome. Eight potentially inappropriate medications (PIMs) were identified and all were continued. Five PIMs were continued because providers felt that the benefit greatly outweighed the risk and 3 were continued according to patient preference after discussions regarding risks. The reviews prompted the discontinuation of 1 medication that was not included in the STOPP criteria due to lack of efficacy.

Conclusions: All assisted living residents’ medications were reviewed using the STOPP criteria. The medication appropriateness review tool created from the STOPP criteria appears efficient and easy to use. Participating providers had a high level of geriatric expertise, which may explain the lack of improved appropriateness following implementation. Use of the STOPP criteria using the medication review checklist and medication appropriateness review tool need to be tested with a larger sample of providers and residents.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Jessica Smith BSN, RN, CCRN-CMC

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