hospital electronic medical record, which has been built by eHealth NSW and tested with junior and senior doctors and pharmacists in NSLHD. As part of the two year project, Prof Hilmer and her colleagues have developed a package of resources for clinicians, consumers and health organisations to make it easier when assessing patients’ medications and safe ways to deprescribe in hospital. Medication review in hospital is in line with patient expectations. One consumer stated, ‘I would suspect it [medication review] would be an essential part of diagnosing of my condition and the reason for my admission to hospital…. I would probably be delighted [to have one of my regular medicines reduced or stopped in hospital] after years of having to take them’. Polypharmacy affects almost one million older Australians. Multiple medication use in older people is often harmful and unnecessary, contributing to the $1.2 billion national annual cost of medicine- related hospital admissions. In her role as a geriatrician at RNSH, Prof Hilmer sees the adverse effects that multiple drugs can have on older people, and the reversibility of these effects when unnecessary medications are deprescribed. This is why she is passionate to change the way medications are reviewed and prescribed during routine care in hospitals. Prof Hilmer has been instrumental in pushing for change nationally. She recently led a national strategic plan calling to halve the use of unnecessary medications in older people. This aligns with the aims of the current World Health Organisation 3rd Global Patient Safety Challenge: Medication without harm.
Reducing medications: implementing review
“Fifty per cent of older Australians are taking medicines that are unnecessary, or where the harm currently outweighs the benefit for them,” said Prof Hilmer. ``There’s been a huge increase in the number of medicines available. People are starting to use them as preventative treatments in middle age and continuing them into old age as they accumulate more medications for more medical problems.” Prof Hilmer is best known for developing the Drug Burden Index, a clinical risk assessment tool to identify an older person’s total exposure to drugs that slow them down, physically and mentally. The effects of these drugs are cumulative and may be misattributed to disease or to ‘just getting old’. In a translational research project funded by NSW Health, she is investigating the best way to integrate medication review using the Drug Burden Index into routine hospital care. Prof Hilmer and her colleagues determined the key features for an electronic decision support system (EDS), which would assist doctors in assessing patients’ medications and safely initiating deprescribing in hospital. This informed development of software integrated with the
and withdrawal of unnecessary medications into
routine hospital care Peak health bodies have welcomed the findings of a two year research project to reduce inappropriate medications for older people in hospital. Professor Sarah Hilmer, Head of Department of Clinical Pharmacology at Royal North Shore Hospital and lead researcher in Ageing and Pharmacology at the Kolling and University of Sydney, recently presented her research to stakeholders from local health districts, primary health networks, the NSW department of health agencies, academics and consumers. Prof Hilmer is leading a team of researchers which is studying the effects of polypharmacy in the elderly and investigating safe ways to withdraw unnecessary medications (deprescribe). Polypharmacy is where a patient takes multiple concurrent medications. It can have unintended and dangerous effects on the elderly, including an increased risk of falls and cognitive impairment.
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KOLLINGNEWS | ISSUE 3 | OCTOBER 2019
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