Rationalisation of Polypharmacy in the Elderly by the RASP Instrument

• Number of potentially inappropriate drug prescriptions as defined by the RASP. [ Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days. ] [ Designated as safety issue: Yes ]
• Actual drug use [ Time Frame: Measured on 30 and 90 days post-discharge. ] [ Designated as safety issue: No ]
• Number and category of drugs adjusted on recommendations of the clinical pharmacist independent of RASP [ Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days. ] [ Designated as safety issue: No ]
• Mortality [ Time Frame: Measured during hospitalisation, an expected average of 14 days and within 90 days after discharge. ] [ Designated as safety issue: Yes ]
• Number of falls [ Time Frame: Measured during hospitalisation, an expected average of 14 days and within 90 days after discharge ] [ Designated as safety issue: Yes ]
• Quality of Life (EQ-5D-3L) [ Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days. ] [ Designated as safety issue: No ]
• Length of stay [ Time Frame: Determined at discharge, on average after 14 days ] [ Designated as safety issue: No ]
• Rehospitalisation [ Time Frame: Within 90 days post-discharge. ] [ Designated as safety issue: No ]
• Incidence of delirium [ Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days ] [ Designated as safety issue: Yes ]
• Number of falls post-discharge [ Time Frame: Within 90 days post-discharge ] [ Designated as safety issue: Yes ]

• Number of potentially inappropriate drug prescriptions as defined by the RASP. [ Time Frame: Measured at admission and at hospital discharge, on average after 14 days. ] [ Designated as safety issue: Yes ]
• Actual drug use [ Time Frame: Measured on 30 and 90 days post-discharge. ] [ Designated as safety issue: No ]
• Number and category of drugs adjusted on recommendations of the clinical pharmacist independent of RASP [ Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days. ] [ Designated as safety issue: No ]
• Mortality [ Time Frame: Measured during hospitalisation, an expected average of 14 days and within 90 days after discharge. ] [ Designated as safety issue: Yes ]
• Number of falls [ Time Frame: Measured during hospitalisation, an expected average of 14 days and within 90 days after discharge ] [ Designated as safety issue: Yes ]
• Quality of Life (EQ-5D-3L) [ Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days. ] [ Designated as safety issue: No ]
• Length of stay [ Time Frame: Determined at discharge, on average after 14 days ] [ Designated as safety issue: No ]
• Rehospitalisation [ Time Frame: Within 90 days post-discharge. ] [ Designated as safety issue: No ]
• Incidence of delirium [ Time Frame: Patients will be followed for the duration of hospital stay, an expected average of 14 days ] [ Designated as safety issue: Yes ]
• Number of falls post-discharge [ Time Frame: Within 90 days post-discharge ] [ Designated as safety issue: Yes ]

The aim of this study is to determine whether a clinical pharmacist using the RASP list (RASP = Rationalisation of home medication by an adjusted STOPP-list in older patients; STOPP = Screening Tool of Older Persons' potentially inappropriate Prescriptions) can optimise the drug use in elderly inpatients.

Older persons take on average multiple drugs. As people age, there is an apparent increase in pharmacodynamic sensitivity to different making the patient more prone to experience side effects. Alterations in body composition and concomitant changes in pharmacokinetic parameters can also result in a higher risk for adverse drug events. All these factors make the older person, notwithstanding the heterogeneity of this population, more vulnerable for the negative consequences of polypharmacy.

Polypharmacy is a cause of negative clinical outcomes but it still remains unclear which intervention or set of interventions should be used to optimize the prescription of pharmacotherapy in the elderly patient. Therefore, the investigators developed the RASP (RASP = Rationalisation of home medication by an adjusted STOPP-list in older patients; STOPP = Screening Tool of Older Persons' potentially inappropriate Prescriptions), a list as tool to reduce polypharmacy adapted to Belgian national prescribing tendencies within geriatric wards. Content and reliability of the RASP have been validated and the investigators aim to further study the impact of the systematic implementation of this RASP on geriatric wards in a prospective cluster randomized controlled trial.

• Active Comparator: RASP
  Intervention: Other: Pharmaceutical care plan, mostly based on the RASP
• No Intervention: Control group
  Subjects enrolled in this arm will undergo usual medical and pharmaceutical care with registration of drug use at admission and discharge without interference of RASP or clinical pharmacist.

Inclusion Criteria:

• Signed informed consent by the patient or a caregiver if the patient is incompetent to sign
• Consecutive inclusion of all newly admitted patients to the wards coming from home or the emergency room department

Exclusion Criteria:

• Patients not admitted to the hospital from home or a nursing home
• Patients unable to communicate in Dutch
• Patients admitted for palliative care
• Patients who do not take any drugs at admission