Using prescribing indicators to measure the quality of prescribing to elderly medical in‐patients

Objectives: to evaluate the performance of hospitals using eight indicators designed to assess prescribing practice in medical in‐patients aged ≥65 years. Design: local coalition teams were invited to collect cross‐sectional prescribing and clinical data on 100 consecutive medical in‐patients aged ≥65 years during a specific week in April 1999. Setting: 102 hospitals across England. Participants: all NHS Trust hospitals in Wales and England were invited to participate in the study. Main outcome measures: the performance and inter‐hospital variation of hospitals in eight indicators of prescribing. Also, the age‐related appropriate use of anti‐thrombotic stroke prophylaxis in atrial fibrillation, of aspirin in angina and of benzodiazepines. Results: data were collected on 9,979 patients prescribed 70,458 medications. The number of hospitals achieving the prescribing goal for the indicators varied between 0 and 70. Frequency of administration instructions with ‘as required’ prescriptions were documented on 60% (10,403/17,258) of occasions. Generic (or acceptable proprietary) names were used for 84% (58,953/70,458) medications, 50% (4,870/9,778) of patients had documentation of allergy status on the drug chart and 23% (1,380/6,060) of patients had the potential risk of exceeding the maximum recommended dosage (4 g/24 h) of paracetamol. Long‐acting hypoglycaemic drugs were prescribed to 50 patients. Anti‐thrombotic stroke prophylaxis in atrial fibrillation were used appropriately for 53% (805/1,518) of patients, aspirin was used appropriately in angina for 90% (952/1,052) of patients and benzodiazepines were used appropriately for 49% (824/1,689) of patients. For the latter three indicators, the appropriate use of medications declined from 60% to 44%, 95% to 85% and 53% to 44% in patients aged ≥85 years compared with those aged 65–74 years. Conclusions: prescribing indicators were effective in evaluating the performance of 102 hospitals on prescribing practice to medical in‐patients aged ≥65 years. Prescribing to elderly medical in‐patients is sub‐optimal but targets were achieved by some hospitals. This should inspire those hospitals not achieving high standards to improve their performance. The higher level of inappropriate prescribing with increasing age is unacceptable.