HPE 101 – July 2022 | Page 26

TABLE 1
Patient episodes with specific ACB score
All five wards n = 212
Subgroup of two wards n = 59
Patients with ACB score of 0 at admission
81 ( 38 %)
19 ( 32 %)
Patients with ACB score of 1 at admission
46 ( 22 %)
14 ( 24 %)
Patients with ACB score of 2 at admission
34 ( 16 %)
12 ( 20 %)
Patients with ACB score of ≥3 at admission
51 ( 24 %)
14 ( 24 %)
Patients with ACB score of 0 at final day on the ward
44 ( 21 %)
16 ( 59 %)
Patients with ACB score of 1 at final day on the ward
45 ( 21 %)
14 ( 24 %)
Patients with ACB score of 2 at final day on the ward
46 ( 22 %)
10 ( 17 %)
Patients with ACB score of ≥3 at final day on the ward
77 ( 36 %)
19 ( 32 %)
TABLE 2
ACB score at admission and at discharge
All five wards n = 212
Subgroup of two wards n = 59
Total ACB score at admission for all spells
322
105
Total ACB score at final day on the ward for all spells
456
120
Total ACB score at admission for spells of ≥ 5 days
79
33
Total ACB score at final day on the ward for spells of ≥ 5 days
125
41
Patient spells with an ACB score reduction between admission and final day on the ward
20 ( 9 %) with total score decrease of 27
9 ( 15 %) with total score decrease of 13
Patient spells with no ACB score change 113 ( 53 %) 34 ( 58 %)
Of above , patient spells with no ACB score change but who did start with a score of ≥1
73 / 109 ( 65 %) 22 / 34 ( 65 %)
Patient spells with an ACB score increase between admission and discharge
79 ( 37 %) with total score increase of 161
16 ( 27 %) with total score increase of 28 of patients at risk of anticholinergic side effects at Clinical Commissioning Group , Primary Care Network and GP Practice level , and to prioritise work in this area . 10 However , ACM use in a hospital setting has been less extensively studied and with varying results . ACM prescription was found in 10 % of hospitalised , older patients using a database from a French general hospital covering 14,090 hospital stays by patients aged 75 and over . 11 A Danish study , utilising the Anticholinergic Risk Scale , examined the association between ACM at hospital admission and mortality in older patients and found that such use is associated with short- and long-term mortality in geriatric patients , even when adjusting for other important variables such as comorbidity and activities of daily living . 12 In this Danish study , nearly two-thirds of a total of 74,589 patients received ACM . Few patients received medications with an ACB score of two or three while a score of one accounted for 88.1 % of the overall anticholinergic intake .
Previously in our Trust , a RADAR ( RCHT Analysis , Data and Reporting ) report had been developed that pulls daily prescribing data for ACM from the hospital ’ s e-prescribing system ( CareFlow Medicines Management ) for patients on five selected wards . These wards covered elder care , trauma ( mainly older patients ), stroke , and neurology . For each patient , the report generates the total ACB score , together with the names of any drugs that fall into the categories of an ACB score of 1 , 2 , or 3 . This report was developed using the Ageing Brain Care scoring system . 13 Patient characteristics ( age and gender ) are also displayed . The intention was that this report would be used by clinical staff to identify those patients with a high ACB who might be suitable for a medication review . However , a previous unpublished internal study has found that this electronically available report was not used by clinicians , mainly because of a lack of compatibility with workflow .
Our overall aim was to identify if the ACB score altered
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