FIRST STEPS TOWARDS TAILORING FRAILTY SPECIFIC CLINICAL PHARMACY REFERRALS

Abstract Ref: 
0101

Aine O’Reilly1, Vince Athanasiyar2, Siobhan Ryan2, Ciara Pender2, Jennifer Maher2, Karen
Sayers2, Eamonn Cooney2, Binish Baburaj1,Christina Donnellan1, Isweri Pillay1
1South Tipperary General Hospital, Clonmel, Ireland
2South Tipperary General Hospital, Clonmel, Tipperary, Ireland

Background: Interdisciplinary frailty assessment teams are in development throughout
Ireland. Clinical pharmacy assessment (CPA) improves patient outcomes. Review is time
consuming. Prioritising patients using frailty-specific toolkits should result in the greatest
benefit for patients in a resource-limited setting.

Methods: Consecutive acute emergency patients identified as Variable Indicative of Placement
positive at triage, underwent standardised interdisciplinary assessment tool. Age,
gender, reason for referral and clinical frailty score were recorded in an Excel database. From
7/1/2019 to 31/1/2019, polypharmacy, defined as 5 or more medications triggered CPA.
In phase 2, 11/3/2019 to 5/4/2019, a prioritisation toolkit was used.This toolkit identified
4 groups. 1. Regular use of high-risk medication or greater than 10 medications. 2.
Patients with specific pharmaceutical concerns eg. desire to reduce their medication burden;
3. Acute/Chronic Kidney Injury; 4. Medication related admission potentially related to
medications or admitted with non-mechanical falls.

Results: In phase 1, 57 patients were referred with polypharmacy from 7/1/2019 to
31/1/2019. 49%(n=27) received CPA. The mean age(+/_SD) was 82.8(+/-6.5). The
female to male ratio was 1:1.Theaverage CFS score(+/-SD) was 5.8(+/-1.2). In phase 2, 45
patients were prioritised with the toolkit from11/3/2019 to 5/4/2019. 55%(n=25) received
CPA. The mean age was 81.1(+/-8.3). The female to male ratio was higher (2.8:1). The
average CFS score was 5.9(+/-0.9).

Conclusion:The prioritisation toolkit slightly reduced the number of referrals forCPA.The
total number of CPAs remained constant. Women accounted for a greater percentage of
patients in phase 2, consistent with previously published work. Further prioritisation is
needed to ensure that patients with the highest risk of medication-related safety issues are
identified and reviewed. Further prioritisation will be trialled and analysed using a plan, do,
study, act approach.The ultimate aim will be to create and validate a prioritisation toolkit
for the frail elderly presenting through an emergency department.