3163 Reducing the anticholinergic burden of patients in the inpatient and outpatient setting

Abstract Introduction Anticholinergic medications are associated with cognitive decline and increased risk of falls. This link is dose dependent and has been shown to decrease with medication discontinuation, therefore reducing the anticholinergic burden of patients represents an opportunity to prevent patient harm and improve quality of life. This project aims to improve patients’ anticholinergic burden (ACB) scores following admission to Meadowlands Care of the Elderly Unit and presentation to the Frailty Assessment Unit. Methods We began by conducting two simultaneous audits in the inpatient and outpatient setting. We audited ACB scores on presentation and on discharge from the inpatient ward or following clinic review as appropriate. We then completed two PDSA cycles. Our first intervention involved a teaching session for doctors on the risks associated with anticholinergic medication and the benefits of reducing ACB scores. Our second intervention was a poster directing staff to the ACB calculator and raising awareness of the risks of anticholinergic medications for our patients. Results In both the inpatient and outpatient setting, and regardless of intervention, the average ACB score improved following admission or outpatient review. In the inpatient setting the average reduction was 0.57, and in the outpatient setting the average reduction was 0.35. However, there was no clear improvement in the reduction of ACB scores associated with any of our interventions. Conclusion While it was encouraging to see that following admission under the Care of the Elderly Team or after review at the Frailty Assessment Unit there was a reduction in patients’ anticholinergic burden, this reduction is small and could potentially be improved. Unfortunately, our interventions did not bring about this improvement. There are multiple possible reasons for this, including the rotational nature of trainee medical staff and the lack of pharmacist involvement.