Drug Burden Index Medication Review The Drug Burden Index (DBI) measures total exposure to medicines with anticholinergic and sedative effects which may impair physical and cognitive function. The DBI is validated as a clinical risk assessment tool in practice. It is built into the eMR and calculates the DBI for each patient admitted. Ryde Hospital participated in a Multi-Centre Cluster Randomised Controlled Trial in 2022/23 which involved an intensive DBI stewardship intervention to look at the impact on prescribing, readmission, mortality; as well as clinician and patient feedback. A stewardship pharmacist worked with the medical, pharmacy and nursing teams on 4 study wards to facilitate use of the DBI in eMR to prompt and inform medication review. Ryde has followed on from the trial to embed the DBI risk assessment into the clinical review of patient’s medications. The Ryde Hospital Medication Safety and Quality Committee recently endorsed the Work Instruction for the Multidisciplinary Drug Burden Index Medication Review. The purpose of this work instruction is to outline the process undertaken by the ward multidisciplinary team in conducting medication review with a focus on reducing falls risk and drug burden. Any inpatients with a drug burden index (DBI) score of greater than zero or identified as having challenging behaviours or high falls risk should be reviewed. The DBI score indicates total exposure to anticholinergic and sedating medications. This review is to be undertaken by the multidisciplinary team comprising of the treating medical team, ward pharmacist and ward-based leadership team (Nurse Unit Manager, Clinical Nurse Educator and/or Clinical Nurse Specialists). Medications contributing to DBI are rationalised if possible and opportunities to titrate or deprescribe are discussed and documented. Deprescribing guidelines such as those published by the NSW Therapeutic Advisory Group are used as appropriate. The consumer should be actively involved where possible in making decisions concerning their medications. The Multidisciplinary Drug Burden Index Medication Review currently takes place fortnightly on Graythwaite and weekly on Ward 7. Our other wards will be implementing this review process soon. This activity aligns with the National Safety and Quality Health Service Standards 4, Medication Safety as well as 2, Partnering with Consumers, 8 Recognising Responding to Acute Deterioration Standard and 5 Comprehensive Care.
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