Intervention for improving the appropriateness of physician orders for oral medications in geriatric VIP patients during the journey to JCI accreditation

Correspondence: Quan Zhou Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang 310009, China Tel +86 571 8778 4615 Fax +86 571-8702 2776 Email [email protected] Dear editor We read with great interest the study by Fadare et al, who assessed the prescribing pattern for elderly Nigerian outpatients and concluded that polypharmacy and the prescription of potentially inappropriate medications are major therapeutic issues in Nigeria, and there is a need for prescriber training and retraining with emphasis on the geriatric population. We completely agree with Fadare et al’s point of view that a low proportion of patients with potentially inappropriate medications highlights the importance of information technology in medication management. We discuss and share our perspectives in the following paragraphs. Geriatric patients may suffer from multiple chronic diseases and receive more medications compared to younger patients. Medication therapy management (MTM) services provide essential reviews of drug regimens and are increasingly recognized as beneficial to patient safety, improved health outcomes, and cost savings. Undoubtedly, the elderly patients especially need MTM services. The Joint Commission International (JCI) accreditation standard has strict requirements for rational drug use. Irrational drug use includes inappropriateness of the drug, dose, frequency and route of administration, real or potential drug–drug interactions (DDIs), allergies, therapeutic duplications, and variation from organization criteria for use. The study of Fadare et al indicates that irrational drug use is still a major issue internationally. Our hospital successfully passed JCI accreditation on Feb 24, 2013 and became the first accredited academic medical center hospital, globally. Very recently, we randomly evaluated the physician orders for oral medications in geriatric very important person (VIP) wards of our hospital before and after JCI accreditation so as to illustrate the effectiveness of clinical interventions during the journey to JCI accreditation. Geriatric patient information and indicators of rational drug use are presented in Table 1. The results of our survey show that the proportion of drug-related problems (DRPs) decreased significantly from 13.0% (before JCI accreditation) to 3.5% (after JCI accreditation) (P , 0.01). Statistically significant changes (as decreasing) in five indicators demonstrated statistically significant changes (P , 0.01 or P , 0.05), ie, DDIs with potential adverse consequences, therapeutic duplication or combination use of two drugs within the same therapeutic or structurally similar class, and inappropriate dosing time, dosing frequency and dosing route. Seven DDIs with potential adverse consequences occurred before JCI accreditation whereas no adverse DDIs Dovepress