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
26 | Issue 101 | hospitalpharmacyeurope . com