CLINICAL RISK MANAGEMENT RELATED TO DRUG THERAPY IN DYSPHAGIC PATIENTS

BACKGROUNG: Problems related to swallowing difficulties (or dysphagia) in elderly people correspond to difficulties in the deglutition process of solid oral dosage forms (SODFs) such as tablets or capsules. In addition, SODFs are the most common pharmaceutical dosage forms (DFs) available on market. As a consequence, manipulation activities of SODFs are frequently carried out and required to allow the administration of the drug therapy to hospitalized dysphagic people. This practice is associated with drug related problems (DRPs) and exposes the patient and the nurses/caregivers to several risks such as administration errors and inappropriate prescriptions. The manipulation concerns crushing tablets or opening capsules to delivery drugs through a naso-gastric tube (NGT). This retrospective study involved older dysphagic patients admitted in the INRCA (Italian National Research Centers on Aging) hospital. OBJECTIVE: The aim of this investigation was to evaluate the suitability of the home and hospital drug therapy in geriatric patients following a polytherapy and with swallowing difficulties. In addition, this study aimed to highlight the DRPs and to evaluate any statistically significant differences between the %DRPs for outpatients (in home therapy) and %DRPs for inpatients (in hospital therapy). METHOD: 45 patients (age>65 years), admitted in INRCA hospital, were recruited from different hospital units (geriatric and neurological) in the period between January and April 2015 and their home/hospital therapies were compared. All patients assumed at least 5 different medications and had swallowing difficulties. The prescribed drugs were 278 during the home therapy, while were 380 during the hospitalization. The data collection was performed through the review of medical records, the consulting among physicians, nurses, and relatives/caregivers when they were discharged. All DRPs derived from manipulation of the original DFs for allowing to dysphagic patients to continue their pharmacological therapy. Data were elaborated through Anderson-Darling Normality test (or t-test for paired data) with p-value 0.05 and 95% confidence interval. RESULTS: The outcomes revealed that more than 90% of admitted patients suffered from dysphagia and a NGT was inserted in about 55% of them. The number of prescribed drugs increased from 6.18 in outpatients to 8.44 in inpatients, but, nevertheless, therapeutics errors were more frequent (37.1% versus 35%) at home than in hospital. Instead, 2.1% of drug-drug or drug-food interactions were detected during the hospitalization and 1.4% before the admission in the hospital. To evaluate any statistical differences between %DRPs for each in-/outpatient, t-test for paired data was performed. No statistically significant differences were revealed. CONCLUSION: The results of this report have not revealed statistical differences due to low impact on clinical practice. In fact, this is a retrospective, small scale, and not properly interventional study. Moreover, the detections were performed on the medical records. Strict physicians/pharmacists collaboration is advisable to affect the future drug prescriptions, to review therapy and to reduce the frequency, costs and length of the hospital admission for elderly patients.