101 First Steps Towards Tailoring Frailty Specific Clinical Pharmacy Referrals

Abstract

Background: Interdisciplinary frailty assessment teams are in development throughout Ireland. Clinical pharmacy assessment (CPA) improves patient outcomes. Review is time consuming. Prioritising patients using frailty-specific toolkits should result in the greatest benefit for patients in a resource-limited setting. Method(s): Consecutive acute emergency patients identified as Variable Indicative of Placement positive at triage, underwent standardised interdisciplinary assessment tool. Age, gender, reason for referral and clinical frailty score were recorded in an Excel database. From 7/1/2019 to 31/1/2019, polypharmacy, defined as 5 or more medications triggered CPA. In phase 2, 11/3/2019 to 5/4/2019, a prioritisation toolkit was used. Tis toolkit identified 4 groups. 1. Regular use of high-risk medication or greater than 10 medications. 2. Patients with specific pharmaceutical concerns eg. desire to reduce their medication burden; 3. Acute/Chronic Kidney Injury; 4. Medication related admission potentially related to medications or admitted with non-mechanical falls. Result(s): In phase 1, 57 patients were referred with polypharmacy from 7/1/2019 to 31/1/2019. 49%(n=27) received CPA. Te mean age(+/-SD) was 82.8(+/-6.5). Te female to male ratio was 1:1. Te average CFS score(+/-SD) was 5.8(+/-1.2). In phase 2, 45 patients were prioritised with the toolkit from 11/3/2019 to 5/4/2019. 55%(n=25) received CPA. Te mean age was 81.1(+/-8.3). Te female to male ratio was higher (2.8:1). Te average CFS score was 5.9(+/-0.9). Conclusion(s): Te prioritisation toolkit slightly reduced the number of referrals for CPA. Te total number of CPAs remained constant. Women accounted for a greater percentage of patients in phase 2, consistent with previously published work. Further prioritisation is needed to ensure that patients with the highest risk of medication-related safety issues are identified and reviewed. Further prioritisation will be trialled and analysed using a plan, do, study, act approach. Te ultimate aim will be to create and validate a prioritisation toolkit for the frail elderly presenting through an emergency department.