Journal ArticleDOI
Polypharmacy in hospitalized older adult cancer patients: experience from a prospective, observational study of an oncology-acute care for elders unit.
Reads0
Chats0
TLDR
It was found that polypharmacy was common in older cancer patients and increased during hospitali-zation, and most OACE team recommendations communicated to physicians were implemented even though the primary physicians were not members of the O ACE team.Abstract:
Background: A novel Oncology-Acute Care for Elders (OACE) unit that uses an interdisciplinary team to enhance recognition and management of geriatric syndromes in hospitalized older adult cancer patients has been established at Barnes-Jewish Hospital (St. Louis, Missouri). The OACE team includes a clinical pharmacist whose primary role is to improve the appropriateness of prescribing. Objective: Using polypharmacy as the prototypical geriatric syndrome addressed by the OACE team, the objective of this study was to document the processes of communication of an interdisciplinary team and the impact on polypharmacy when the treating physician did not participate in the daily interdisciplinary team rounds. Methods: This was a prospective, observational study of older cancer patients admitted to the OACE unit. We tracked processes and outcomes of interdisciplinary communication regarding medications by prospectively recording OACE team recommendations and evaluating the frequency of implementation of these recommendations through a chart review. Treating physicians, who did not attend team rounds, received these recommendations on a communication form placed in the patient's chart. Results: Forty–seven patients were included in the study. The mean (SD) age was 73.5 (7.5) years. Twenty–one percent (10/47) of patients were prescribed ≥1 Beers medication as part of their home-care regimen before admission to the OACE unit. The OACE team made 51 medication recommendations, and 42 of those recommendations (82%) were implemented. Twenty–five patients (53%) had an alteration in their medication regimen; 13 (28%) had a potentially inappropriate medication discontinued. A medication error was corrected in ~1 of every 8 patients (6/47 [13%]). Conclusions: We found that polypharmacy was common in older cancer patients and increased during hospitali-zation. We also found that most OACE team recommendations communicated to physicians were implemented even though the primary physicians were not members of the OACE team. Future randomized trials are needed to assess the impact of the OACE team model of care on adverse events, survival, and cost in hospitalized older adult cancer patients.read more
Citations
More filters
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines
TL;DR: Lymphedema is a common complication after treatment for breast cancer and factors associated with increased risk of lymphedEMA include extent of axillary surgery, axillary radiation, infection, and patient obesity.
Journal ArticleDOI
Evaluating the older patient with cancer: understanding frailty and the geriatric assessment.
TL;DR: Key studies from the geriatric literature that provide principles for assessing health status in the older patient are described, and ways that these principles can be applied to oncology care in an older population are proposed.
Journal ArticleDOI
Senior Adult Oncology
Arti Hurria,Ilene S. Browner,Harvey J. Cohen,Crystal S. Denlinger,Mollie deShazo,Martine Extermann,Apar Kishor Ganti,Jimmie C. Holland,Holly M. Holmes,Mohana Karlekar,Nancy L. Keating,June M. McKoy,Bruno C. Medeiros,Ewa Mrozek,Tracey O'Connor,Stephen H. Petersdorf,Hope S. Rugo,Rebecca A. Silliman,William P. Tew,Louise C. Walter,Alva B. Weir,Tanya M. Wildes +21 more
TL;DR: The aging of the U.S. population and increased life expectancy of the elderly mean that cancer in older adults is becoming an increasingly common problem.
Journal ArticleDOI
Polypharmacy in Older Adults with Cancer
TL;DR: The adverse outcomes associated with polypharmacy are outlined, the strengths and weaknesses of these definitions offered are examined, and the relationships among these definitions are explored.
Journal ArticleDOI
Studies to Reduce Unnecessary Medication Use in Frail Older Adults: A Systematic Review
TL;DR: Very little rigorous research has been conducted on reducing unnecessary medications in frail older adults or patients approaching end of life, and intervention effect sizes could not be determined due to heterogeneity of study designs, samples, and measures.
References
More filters
Journal ArticleDOI
The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II
Lucian L. Leape,Troyen A. Brennan,Nan M. Laird,Ann G. Lawthers,A R Localio,B A Barnes,Liesi E. Hebert,Joseph P. Newhouse,Paul C. Weiler,Howard H. Hiatt +9 more
TL;DR: The high proportion that are due to management errors suggests that many others are potentially preventable now, and reducing the incidence of these events will require identifying their causes and developing methods to prevent error or reduce its effects.
Journal ArticleDOI
Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.
Donna M. Fick,James W. Cooper,William E. Wade,Jennifer L. Waller,J. Ross Maclean,Mark H. Beers +5 more
TL;DR: The application of the Beers criteria and other tools for identifying potentially inappropriate medication use will continue to enable providers to plan interventions for decreasing both drug-related costs and overall costs and thus minimize drug- related problems.
Journal ArticleDOI
A multifactorial intervention to reduce the risk of falling among elderly people living in the community.
Mary E. Tinetti,Dorothy I. Baker,Gail McAvay,Elizabeth B. Claus,Patricia Garrett,Margaret Gottschalk,Marie L. Koch,Kathryn Trainor,Ralph I. Horwitz +8 more
TL;DR: The multiple-risk-factor intervention strategy resulted in a significant reduction in the risk of falling among elderly persons in the community and among persons who had the targeted risk factors for falling, as compared with the control group.
Journal ArticleDOI
Effect of computerized physician order entry and a team intervention on prevention of serious medication errors.
David W. Bates,Lucian L. Leape,David J. Cullen,Nan M. Laird,Laura A. Petersen,Jonathan M. Teich,Elizabeth Burdick,Mairead L. Hickey,Sharon Kleefield,Brian T. Shea,Martha Vander Vliet,Diane L. Seger +11 more
TL;DR: Physician computer order entry decreased the rate of nonintercepted serious medication errors by more than half, although this decrease was larger for potential ADEs than for errors that actually resulted in an ADE.
Journal ArticleDOI
The costs of adverse drug events in hospitalized patients
David W. Bates,Nathan Spell,David J. Cullen,Elisabeth Burdick,Nan M. Laird,Laura A. Petersen,Stephen D. Small,Bobbie Jean Sweitzer,Lucian L. Leape +8 more
TL;DR: The substantial costs of ADEs to hospitals justify investment in efforts to prevent these events, and estimates of annual costs attributable to all ADEs and preventable ADEs for a 700-bed teaching hospital are $5.6 million and $2.8 million are conservative because they do not include the costs of injuries to patients or malpractice costs.
Related Papers (5)
Polypharmacy in elderly patients with cancer: clinical implications and management.
Judith Lees,Alexandre Chan +1 more