Slide Presentation from the AHRQ 2007 Annual Conference

Quality Indicators for Appropriate Medication Use in Older Adults Assessing Care of Vulnerable Elders (ACOVE)

• Warfarin: INR should be monitored using standardized protocols
• Loop diuretics: Check electrolytes within 1 week and at least annually
• Avoid chlorpropamide
• Avoid drugs with strong anticholinergic properties
• Avoid barbiturates
• Avoid meperidine
• ACE inhibitors: Monitor renal function and potassium in patients on ACE inhibitors

Notes:

Study establishes the extent and seriousness of the problem
clarifies the potential for prevention
lays the ground work for determining what directions needed in designing interventions
We believe this is a very conservative estimate—tip of the iceberg, because:
used medical record review—limits in quality of nursing home records strictly information entered or reported by providers
high end homes rigid about definition of ADE—had to be strong evidence linking symptoms to drug