Development and validation of an improving prescribing in the elderly tool

Area of Science:

• Geriatric Medicine
• Pharmacology
• Health Services Research

Background:

• Potentially inappropriate prescriptions (PIPs) are a significant concern in elderly patients.
• Existing screening methods may lack brevity or comprehensive validation.
• There is a need for a reliable tool to identify PIPs in hospitalized older adults.

Purpose of the Study:

• To develop and validate a brief screening tool for potentially inappropriate prescriptions in the elderly.
• To apply consensus panel guidelines to hospital inpatient charts for tool development.
• To assess the reliability and validity of the new screening tool.

Main Methods:

• A retrospective chart review of 361 inpatient records from a clinical teaching unit and a geriatric assessment unit.
• Development of the Improving Prescribing in the Elderly Tool (IPET) based on identified PIPs.
• Validation through construct validity (comparing PIP rates between units) and interrater reliability testing.

Main Results:

• The IPET was constructed using 45 PIPs identified in 12.5% of patients.
• The tool demonstrated construct validity by showing a difference in PIP rates between the clinical teaching unit and geriatric assessment unit.
• Excellent interrater reliability (kappa = 1.0) was achieved when applying the IPET to a new set of charts.

Conclusions:

• The IPET is a brief, reliable, and valid screening tool for potentially inappropriate prescriptions in elderly inpatients.
• The tool is based on published literature and consensus guidelines.
• IPET can assist healthcare providers in identifying and potentially reducing PIPs in older adults, improving medication safety.