Application of STOPP Criteria and Beers Criteria in an inpatient psychiatric facility and impact on utilization of potentially inappropriate medications and adverse outcomes

Abstract

Background: The Beers Criteria and STOPP Criteria were developed to identify potentially inappropriate medications (PIMs) in the geriatric population. Utilization of STOPP Criteria PIMs have shown a significant association with presence of avoidable adverse drug events (ADEs) as compared to utilization of Beers Criteria PIMs. Objectives: The purpose of this study was to utilize STOPP and Beers Criteria to identify PIMs in geriatric patients at an inpatient psychiatric facility, with the goal of implementing a formal process for assessing medication regimens. This process would be expected to decrease adverse outcomes. Methods: Both criteria were used by the pharmacist to identify PIMs and recommendations were made to address the PIMs. A retrospective chart review evaluated whether utilization of the two criteria led to a significant change in number of PIMs and associated adverse outcomes. The primary outcome was the change in number of PIMs for the Beers Criteria versus the STOPP Criteria. Secondary outcomes included the change in number of PIMs, falls, required referrals/transfers, and medication-specific ADEs for each set of criteria assessed separately. Results: Twenty-nine patients met inclusion criteria, and 76 treatment recommendations were made. More PIMs per patient were identified at baseline utilizing STOPP (mean±SD,3.9±2.3) versus Beers Criteria (mean±SD, 2.2±1.3) (p<0.001). The number of PIMs decreased using STOPP (from 112 to 66; mean decrease per patient -1.6±1.5, p<0.0001) and Beers Criteria (from 63 to 23; mean decrease per patient -1.4±1.1, p<0.0001), although the change was not significant for STOPP vs. Beers (p=0.375). All secondary outcomes decreased using both criteria. Conclusions: Utilization of each set of criteria by the pharmacist led to a significant decrease in PIMs and adverse outcomes decreased at follow-up using both criteria. Implementation of a process for assessing medication regimens of geriatric patients utilizing the Beers and/or STOPP Criteria would likely be beneficial to this institution. As previously stated, clinical judgment weighed heavily in assessing PIMs for appropriateness and determining appropriate recommendations to address the use of PIMs. Therefore, although it may be possible to implement tools or screening processes to identify PIMs, a healthcare provider with specialized training in treating this patient population is necessary to appropriately apply the criteria. A clinical pharmacist is an optimal member of the healthcare team to provide this service due to specialized training in assessing medication regimens. Of note, several of the medications included in the criteria are psychotropic medications, making this a potentially beneficial service in a psychiatric facility in particular.