4CPS-224 Analysis of interventions in polymedicated elderly patients

Background Elderly patients are fragile, pluripatologicsa, chronic, and polytechnic populations. These characteristics added to others such as physiological, pharmacokinetic and pharmacodynamic changes, the attention by various specialists and at levels of care, make them a group that requires special care. There are several criteria to improve the prescription quality in this group of patients, among which we find the STOPP/START criteria. The optimisation of treatments and their adequacy in this group of patients also contemplates aspects such as deprescription, monitoring, dose adjustments or conciliation. Purpose Analysis and determination of the degree of acceptance of pharmaceutical interventions (PI) performed in a third-level hospital in elderly patients. Material and methods Retrospective descriptive study of pharmaceutical interventions performed between January 2016 and August 2017 in patients over 65 years of age. The Farmatool ® and Medora ® programs have been used to classify the interventions and check the chronic medication prescribed for primary care. The variables recorded were: demographic data of the patient, service involved, drug involved and reason for PI. Interventions were classified as: therapeutic equivalent, conciliation, dose adjustment in elderly patients, allergies, interactions, duplications, pattern changes, adjustment in renal/hepatic insufficiency, conciliation, incomplete medical order and others. In addition, the interventions were analysed to show how many of them met STOPP/START criteria. Apart from that, the acceptance of the interventions was evaluated. Results During the study period, 1,127 PI were recorded in elderly patients with a mean age of 79 years. According to the classification, the following results were obtained: therapeutic equivalent: 158, conciliation: 39, dose adjustment in elderly patients: 159, allergies: 40, interactions: 228, duplicity: 102, renal/hepatic adjustment: 75, incomplete medical orders: 45, others: 281, STOPP/START criteria: 497. The degree of acceptance of the recommendations was 45%. The service with the most interventions was internal medicine. Conclusion There have been a large number of interventions that have helped to avoid medication errors and have increased the quality of care. The participation and intervention of the pharmacist is of great help in the detection and resolution of potential medication errors. References and/or Acknowledgements STOPP/START criteria. No conflict of interest