고령 환자의 안전한 약물 요법을 위한 관리지표 개발

Abstract

Since geriatric patients are frequently subjected to polypharmacy and have altered pharmacokinetic/pharmacodynamic characteristics, the frequency for adverse drug event and drug interaction is likely to be elevated for the patients. To improve the safety of pharmacotherapy for geriatric patients, clinical indicator was developed and implemented in inpatient pharmacy for patients over 65 years of age Seoul National University Bundang Hospital. First, a number of relevant drug lists (e.g., drugs that are not appropriate for elderly patients according to Beers Criteria; drugs that require dose adjustment in renally insufficient patients; drugs that becomes less effective if the integrity is compromised) were prepared and posted various means (e.g., via groupware notice as well as to notice-boards). Second, a lecture, entitled ‘Polypharmacy and inappropriate drugs for elderly patients’was organized to other health care professionals, including physicians. In addition, patient's medication profile was modified to display serum creatinine and creatine clearance of the patient to assist the dosage adjustment. Pharmacists of the inpatient pharmacy may intervene based on the patient information, patient’s creatine clearance, dispensed formulation and prescription of inappropriate drugs. By the implementation of the clinical indicator, the number of inquiry for inappropriate drug use was increased to 92 cases (from 7 cases previously). The acceptance rate for other health care professionals was increased from 29 to 63%. The number of inquiry for dose adjustment was increased to 141 cases (from 22 cases previously). The number of inquiry for dosage forms was increased to 101 cases (from 31 cases previously) along with the acceptance rate to 89.2%. While the current program led to the elevation of the role of pharmacist in the geriatric care and improved the safety of pharmacotherapy for geriatric patients, a more aggressive public relation program, coupled with wider intervention by pharmacists, appears necessary to improve the geriatric patient safety.