Implementation of STOPP/START Review Tool to Minimize Polypharmacy in the Elderly

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Brennan, Keley
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Background: Polypharmacy poses a significant challenge in the elderly, leading to adverse drug reactions, increased healthcare costs, and diminished quality of life for older adults. Effective interventions are needed to optimize medication management in this population. Purpose: The primary objective of the Quality Improvement (QI) project was to identify potentially inappropriate medications (PIMS) using the STOPP tool, with a secondary aim to identify potentially prescribing omissions (PPOs) through the application of the START tool. This initiative aimed to enhance medication management practices ultimately reducing the incidence of polypharmacy and improving patient outcomes. Method: This QI project implemented STOPP and START tools for medication review in a skilled nursing facility. A retrospective chart review compared medication changes before and after the intervention, using a two-tailed Wilcoxon signed-rank test statistical analysis. Intervention: A sole provider conducted quarterly medication reviews using STOPP and START tools. These evidence-based criteria identified PIMs and PPOs, enabling targeted interventions. Results: A significant reduction in medications following implementation (p = .003), using the STOPP tool was found. A secondary analysis of medications that were started using the START tool shows there was no indication that the review tool had a statistical impact (p=.891). Conclusion: This project demonstrates the potential of evidence-based interventions to improve medication management in skilled nursing facilities, enhancing patient outcomes and quality of care for older adults.