Multicomponent Interventions Reduce High-Risk Medications for Delirium in Hospitalized Older Adults

Mobolaji Adeola, Rejena Azad, Gizat M Kassie, Beverly Shirkey, George Taffet, Michael Liebl, Kathryn Agarwal

Research output: Contribution to journalArticle (Academic Journal)

Abstract

Delirium threatens the functional independence and cognitive capacity of patients. Medications, especially those with strong anticholinergic effects, have been implicated as a preventable cause of delirium. We evaluated the effect of multicomponent interventions aimed at reducing the use of 9 target medications in hospitalized older adults at risk of delirium. This continuous quality improvement program was undertaken at a tertiary care facility and 4 community hospitals in a hospital system. We included 21, 541 hospital admissions with patients aged 70 and older on acute care medical or surgical units from the preintervention (2012) period, and 27,764 from the postintervention (2015) period. Implemented interventions include formulary and policy changes, technology-assisted medication review, age-conditional order set modifications, best practice alerts, and education. The proportion of hospital admissions with individual's receiving at least 1 target medication declined from 45.6% to 31.3% (relative reduction (RR)=31.4%) from before to after the intervention, meaning that target medication exposure was avoided in approximately 4,000 older adults. The greatest effect was observed for zolpidem (11.2% to 5.3%, RR=52.6%) and diphenhydramine (12.9% to 7.1%, RR=45%). Furthermore, the mean number of doses administered during all hospital admissions was reduced for 7 of 9 medications. Multicomponent interventions implemented in our hospital system were effective at reducing exposure to target medications in hospitalized older adults at risk of delirium. These systematic changes applied throughout the medication use process are sustained today.

Original languageEnglish
Pages (from-to)1638-1645
Number of pages8
JournalJournal of the American Geriatrics Society
Volume66
Issue number8
DOIs
Publication statusPublished - Aug 2018

Bibliographical note

© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Keywords

  • Aged
  • Aged, 80 and over
  • Cholinergic Antagonists/adverse effects
  • Delirium/chemically induced
  • Delivery of Health Care/methods
  • Female
  • Hospitalization/statistics & numerical data
  • Hospitals/standards
  • Humans
  • Male
  • Risk Factors
  • Risk Management/methods

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