Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 324

Reducing medication errors requires a multifaceted approach involving computerized systems, simplification and standardization of clinical processes, education and training, and wider cultural and organizational change.⁷⁰

Much work has been carried out to reduce medication errors in general. The underlying principles are common to all successful safety and quality improvement processes: systems must be designed to prevent errors from occurring in the first place, make errors more visible when they occur, and limit the effects of errors so they do not lead to harm. Standardization of processes, paying particular attention to high‐risk medications, and involvement and collaboration with both patients and clinicians have been shown to be successful strategies.

Several categories of interventions have been shown to maximize medication safety for older people in particular. Much as for falls or delirium, the first step is to identify and prevent inappropriate prescribing. Assessment instruments such as the Beers Criteria, Screening Tool of Older Persons' Prescriptions (STOPP), and Screening Tool to Alert to Right Treatment (START)⁷¹ give lists of drugs to avoid in older patients. These tools are useful for both the prevention and measurement of inappropriate prescribing. The potential drawbacks of such tools are that they may not be internationally useable, they rely on correct usage by prescribers, and they may not include all classes of relevant drugs.

A crucial intervention to improve medication safety in older people is medication review and medicines reconciliation, both of which should ideally occur routinely at transitions of care and form a crucial part of specialist geriatric assessment. In primary care, various measures have been shown to improve overall medication safety in older patients, including clinical pharmacist intervention, educational measures, and computerized support.³³ As described earlier, one of the problems in assuring appropriate prescribing for older people is that they have often been excluded from relevant large clinical trials, leading to uncertainty about the safest way to prescribe for them. However, this trend seems to be reversing of late, with older people being specifically targeted for recruitment into such trials.⁴⁷