3765 Reducing anticholinergic burden (ACB) within the elderly care wards through implementation of automated alerts

Abstract * Both authors contributed equally to this work. Introduction Polypharmacy is a major risk for older patients aged 65 and above. Commonly prescribed medications may have anticholinergic properties causing dry mouth, constipation, and urinary retention which can exacerbate delirium in older adults1. ACB scores help quantify the cumulative effect of these medications. ACB scores of three or more are associated with confusion, falls and death2. Aim To evaluate whether automated alerts of ACB scores help reduce scores and encourage medication reviews in older patients. Method Over two weeks, automated alerts were set up within the hospital’s online noting system, which is simulated to flag high ACB scores based on inpatient drug charts. The alert identified the total ACB score and highlighted offending medications. Data was collected from 40 patients across four elderly care wards over two weeks, on alternate days. ACB scores were calculated using an online ACB calculator. ACB scores collected before and after two simulated alerts were analysed and compared. Results Out of 40 patients, 12 had an ACB score of 3 or more before the simulated alerts. Following two automated alerts, this reduced to 9 patients, which equates to a 25% reduction. However, in 31 patients, the ACB score remained unchanged. The ACB scores increased in 8 of the 40 patients. Furthermore, lansoprazole was the most common offending drug, followed by tricyclic antidepressants. Conclusion Our study demonstrated that automated reminders could facilitate regular medical reviews and reduce anticholinergic burden in elderly patients. However, this would work better in combination with regular teaching sessions to increase awareness. Importantly, proton pump inhibitors (PPIs) were prescribed to over a quarter of patients. This raises questions about the necessity of these medications in this age group and a potential QIP looking at deprescribing PPIs as per the deprescribing algorithm.