Lightning Learning: STOPP/START in the ED
STOP!
Polypharmacy can increase the risk of drug interactions and adverse reactions, together with reducing the quality of life for patients.
Medication review in the Emergency Department (ED) can:
- Reduce iatrogenic adverse effects.
- Avoid the ‘prescribing cascade’ (prescription of further medications inappropriately when the patient may be experiencing side effects).
- Decrease hospital admissions.
Adverse Drug Events account for approx. 6.5% of all admissions, but more in older people. This leads to increased hospital stay with significant morbidity and mortality.
LOOK
The STOPP/START criteria is validated to help reduce potentially inappropriate prescriptions amongst older people.
- Screening Tool of Older Persons (potentially inappropriate) Prescriptions (STOPP)
- Screening Tool to Alert doctors to the Right Treatment (START)
This decision aid has a series of rules/suggestions related to high-yield problems in prescribing. Always consider reviewing medications when such patients present to the ED.
LEARN
- Polypharmacy Guidance apps: iPhone & Android (NHS Education for Scotland)
- ACB calculator: for calculating your patient's anticholinergic burden. These medications can significantly increase your patient's morbidity and mortality.
- NICE Database of Treatment Effects: accurate guide + data related to medication treatment effects inclusive of number needed to treat.
- STOPP/START Toolkit: consists of a series of rules/suggestions related to high-yield problems in prescribing for older people, both in terms of reducing medication burden (STOPP) and adding in potentially benefical therapy (START).
