Enhancing Medication Safety through implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in Ambulatory Older Adults

Ameena  Alyazeedi; Mohamed  Sherbash; Ahmed Fouaad  Mohamed; Carrie Stewart; Roy Soiza; Moza  Alhail; Abdulaziz  Aldarwish; Derek Stewart; Ahmed Awaisu; Cristin  Ryan; Phyo Kyaw Myint

doi:10.3390/healthcare12121186

Enhancing Medication Safety through implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in Ambulatory Older Adults

Ameena Alyazeedi^* (Corresponding Author), Mohamed Sherbash, Ahmed Fouaad Mohamed, Carrie Stewart, Roy Soiza, Moza Alhail, Abdulaziz Aldarwish, Derek Stewart, Ahmed Awaisu, Cristin Ryan, Phyo Kyaw Myint

^*Corresponding author for this work

Qatar University

Research output: Contribution to journal › Article › peer-review

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Abstract

Introduction: To promote optimal healthcare delivery, safeguarding older adults from the risks associated with inappropriate medication use is paramount. Objective: This study aims to evaluate the effectiveness of implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in ambulatory older adults to enhance medication safety. Method: The QTRIM was developed by an expert consensus panel using the Beers Criteria and contained a list of potentially inappropriate medications (PIMs) based on the local formulary. Using quality improvement methodology, it was piloted and implemented in two outpatient pharmacy settings serving geriatric medicine and dermatology clinics at Rumailah Hospital, Qatar. Key performance indicators (KPIs) using implementation documentation as a process measure and the percentage reduction in PIM prescriptions as an outcome measure were assessed before and after QTRIM implementation. This study was conducted between July 2022 and September 2023. Results: In the outpatient department (OPD) geriatric pharmacy, the prescription rate of PIMs was reduced from an average of 1.2 ± 0.7 PIMs per 1000 orders in 2022 to an average of 0.8 ± 0.2 PIMs per 1000 orders in 2023. In the OPD geriatric pharmacy, the results showed a 66.6% reduction in tricyclic antidepressants (TCAs) (from 30 to 10), a reduction in first-generation antihistamines by 51.7% (29 to 14), and muscle relaxants by 33.3% (36 to 24). While in dermatology, the older adult prescription rate of PIMs was reduced from an average of 8 ± 3 PIMs per 1000 orders in 2022 to a rate of 5 ± 3 PIMs per 1000 orders in 2023; the most PIM reductions were (49.4%) in antihistamines (from 89 to 45), while muscle relaxants and TCAs showed a minimal reduction. Conclusions: Implementing QTRIM with pharmacy documentation monitoring markedly reduced the PIMs dispensed from two specialized outpatient pharmacies serving older adults. It may be a promising effective strategy to enhance medication safety in outpatient pharmacy settings.

Original language	English
Article number	1186
Number of pages	15
Journal	Healthcare
Volume	12
Issue number	12
Early online date	12 Jun 2024
DOIs	https://doi.org/10.3390/healthcare12121186
Publication status	Published - 12 Jun 2024

Bibliographical note

Acknowledgments
We appreciate: all Rumailah Hospital OPD supervisors and staff applying the manual tool, May Abusafa, Rasha Alqatami, Asma Gabkalla, Ahmed. Karawia, Mohamed Magdy, Tresita Jabonette, and all the pharmacy team; the geriatric mental and medicine department team who were involved in reviewing, supporting, and approving the tool, Hanadi Alhamad, Mahmoud Alrefaee, Irfan Muneeb, Marwan Ramadan, Zerak, Ahmed Almohamed; Nasser Masoudi and Abdulrazaq for supporting the project.

Data Availability Statement

The original contributions presented in the study are included in the article/Supplementary Materials, further inquiries can be directed to the corresponding author.

Keywords

older adults
deprescribing
pharmacist intervention
polypharmacy
potentially inappropriate medication (PIM)
medication management
key performance indicators (KPIs)
quality improvement

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Cite this

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title = "Enhancing Medication Safety through implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in Ambulatory Older Adults",

abstract = "Introduction: To promote optimal healthcare delivery, safeguarding older adults from the risks associated with inappropriate medication use is paramount. Objective: This study aims to evaluate the effectiveness of implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in ambulatory older adults to enhance medication safety. Method: The QTRIM was developed by an expert consensus panel using the Beers Criteria and contained a list of potentially inappropriate medications (PIMs) based on the local formulary. Using quality improvement methodology, it was piloted and implemented in two outpatient pharmacy settings serving geriatric medicine and dermatology clinics at Rumailah Hospital, Qatar. Key performance indicators (KPIs) using implementation documentation as a process measure and the percentage reduction in PIM prescriptions as an outcome measure were assessed before and after QTRIM implementation. This study was conducted between July 2022 and September 2023. Results: In the outpatient department (OPD) geriatric pharmacy, the prescription rate of PIMs was reduced from an average of 1.2 ± 0.7 PIMs per 1000 orders in 2022 to an average of 0.8 ± 0.2 PIMs per 1000 orders in 2023. In the OPD geriatric pharmacy, the results showed a 66.6% reduction in tricyclic antidepressants (TCAs) (from 30 to 10), a reduction in first-generation antihistamines by 51.7% (29 to 14), and muscle relaxants by 33.3% (36 to 24). While in dermatology, the older adult prescription rate of PIMs was reduced from an average of 8 ± 3 PIMs per 1000 orders in 2022 to a rate of 5 ± 3 PIMs per 1000 orders in 2023; the most PIM reductions were (49.4%) in antihistamines (from 89 to 45), while muscle relaxants and TCAs showed a minimal reduction. Conclusions: Implementing QTRIM with pharmacy documentation monitoring markedly reduced the PIMs dispensed from two specialized outpatient pharmacies serving older adults. It may be a promising effective strategy to enhance medication safety in outpatient pharmacy settings.",

keywords = "older adults, deprescribing, pharmacist intervention, polypharmacy, potentially inappropriate medication (PIM), medication management, key performance indicators (KPIs), quality improvement",

author = "Ameena Alyazeedi and Mohamed Sherbash and Mohamed, {Ahmed Fouaad} and Carrie Stewart and Roy Soiza and Moza Alhail and Abdulaziz Aldarwish and Derek Stewart and Ahmed Awaisu and Cristin Ryan and Myint, {Phyo Kyaw}",

note = "Acknowledgments We appreciate: all Rumailah Hospital OPD supervisors and staff applying the manual tool, May Abusafa, Rasha Alqatami, Asma Gabkalla, Ahmed. Karawia, Mohamed Magdy, Tresita Jabonette, and all the pharmacy team; the geriatric mental and medicine department team who were involved in reviewing, supporting, and approving the tool, Hanadi Alhamad, Mahmoud Alrefaee, Irfan Muneeb, Marwan Ramadan, Zerak, Ahmed Almohamed; Nasser Masoudi and Abdulrazaq for supporting the project.",

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month = jun,

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doi = "10.3390/healthcare12121186",

language = "English",

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journal = "Healthcare",

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T1 - Enhancing Medication Safety through implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in Ambulatory Older Adults

AU - Alyazeedi, Ameena

AU - Sherbash, Mohamed

AU - Mohamed, Ahmed Fouaad

AU - Stewart, Carrie

AU - Soiza, Roy

AU - Alhail, Moza

AU - Aldarwish, Abdulaziz

AU - Stewart, Derek

AU - Awaisu, Ahmed

AU - Ryan, Cristin

AU - Myint, Phyo Kyaw

N1 - Acknowledgments We appreciate: all Rumailah Hospital OPD supervisors and staff applying the manual tool, May Abusafa, Rasha Alqatami, Asma Gabkalla, Ahmed. Karawia, Mohamed Magdy, Tresita Jabonette, and all the pharmacy team; the geriatric mental and medicine department team who were involved in reviewing, supporting, and approving the tool, Hanadi Alhamad, Mahmoud Alrefaee, Irfan Muneeb, Marwan Ramadan, Zerak, Ahmed Almohamed; Nasser Masoudi and Abdulrazaq for supporting the project.

PY - 2024/6/12

Y1 - 2024/6/12

N2 - Introduction: To promote optimal healthcare delivery, safeguarding older adults from the risks associated with inappropriate medication use is paramount. Objective: This study aims to evaluate the effectiveness of implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in ambulatory older adults to enhance medication safety. Method: The QTRIM was developed by an expert consensus panel using the Beers Criteria and contained a list of potentially inappropriate medications (PIMs) based on the local formulary. Using quality improvement methodology, it was piloted and implemented in two outpatient pharmacy settings serving geriatric medicine and dermatology clinics at Rumailah Hospital, Qatar. Key performance indicators (KPIs) using implementation documentation as a process measure and the percentage reduction in PIM prescriptions as an outcome measure were assessed before and after QTRIM implementation. This study was conducted between July 2022 and September 2023. Results: In the outpatient department (OPD) geriatric pharmacy, the prescription rate of PIMs was reduced from an average of 1.2 ± 0.7 PIMs per 1000 orders in 2022 to an average of 0.8 ± 0.2 PIMs per 1000 orders in 2023. In the OPD geriatric pharmacy, the results showed a 66.6% reduction in tricyclic antidepressants (TCAs) (from 30 to 10), a reduction in first-generation antihistamines by 51.7% (29 to 14), and muscle relaxants by 33.3% (36 to 24). While in dermatology, the older adult prescription rate of PIMs was reduced from an average of 8 ± 3 PIMs per 1000 orders in 2022 to a rate of 5 ± 3 PIMs per 1000 orders in 2023; the most PIM reductions were (49.4%) in antihistamines (from 89 to 45), while muscle relaxants and TCAs showed a minimal reduction. Conclusions: Implementing QTRIM with pharmacy documentation monitoring markedly reduced the PIMs dispensed from two specialized outpatient pharmacies serving older adults. It may be a promising effective strategy to enhance medication safety in outpatient pharmacy settings.

AB - Introduction: To promote optimal healthcare delivery, safeguarding older adults from the risks associated with inappropriate medication use is paramount. Objective: This study aims to evaluate the effectiveness of implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in ambulatory older adults to enhance medication safety. Method: The QTRIM was developed by an expert consensus panel using the Beers Criteria and contained a list of potentially inappropriate medications (PIMs) based on the local formulary. Using quality improvement methodology, it was piloted and implemented in two outpatient pharmacy settings serving geriatric medicine and dermatology clinics at Rumailah Hospital, Qatar. Key performance indicators (KPIs) using implementation documentation as a process measure and the percentage reduction in PIM prescriptions as an outcome measure were assessed before and after QTRIM implementation. This study was conducted between July 2022 and September 2023. Results: In the outpatient department (OPD) geriatric pharmacy, the prescription rate of PIMs was reduced from an average of 1.2 ± 0.7 PIMs per 1000 orders in 2022 to an average of 0.8 ± 0.2 PIMs per 1000 orders in 2023. In the OPD geriatric pharmacy, the results showed a 66.6% reduction in tricyclic antidepressants (TCAs) (from 30 to 10), a reduction in first-generation antihistamines by 51.7% (29 to 14), and muscle relaxants by 33.3% (36 to 24). While in dermatology, the older adult prescription rate of PIMs was reduced from an average of 8 ± 3 PIMs per 1000 orders in 2022 to a rate of 5 ± 3 PIMs per 1000 orders in 2023; the most PIM reductions were (49.4%) in antihistamines (from 89 to 45), while muscle relaxants and TCAs showed a minimal reduction. Conclusions: Implementing QTRIM with pharmacy documentation monitoring markedly reduced the PIMs dispensed from two specialized outpatient pharmacies serving older adults. It may be a promising effective strategy to enhance medication safety in outpatient pharmacy settings.

KW - older adults

KW - deprescribing

KW - pharmacist intervention

KW - polypharmacy

KW - potentially inappropriate medication (PIM)

KW - medication management

KW - key performance indicators (KPIs)

KW - quality improvement

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DO - 10.3390/healthcare12121186

M3 - Article

SN - 2227-9032

VL - 12

JO - Healthcare

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M1 - 1186

ER -

Enhancing Medication Safety through implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in Ambulatory Older Adults

Abstract

Bibliographical note

Data Availability Statement

Keywords

Access to Document

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