Background: Polypharmacy and inappropriate prescribing are risk factors for adverse drug reactions, which commonly cause complications in older people. The STOPP (Screening Tool of Older Persons’ Prescriptions)/START (Screening Tool to Alert Doctors to Right Treatment) criteria are screening tools, which aim to improve prescribing in the elderly. Objectives: The aim was to improve prescribing, using the STOPP/START criteria, for patients aged 65 and above, who were admitted to the Clinical Decisions Unit at University Hospital Lewisham. We focused on the most common prescribing errors in clinical decision unit, an emergency medicine department. Methods: We reviewed all patients aged 65 and above admitted to the Clinical Decisions Unit in September. Data was collected from clinical documentation and archived drug charts. This pilot study of 114 patients revealed the most common prescribing errors, of which 8 were STOPP and 11 were START criteria. A plan–do–study–act methodology was implemented over 1 month, involving presentations, emails and posters. Prescribing patterns were then reviewed over 4 weeks in December in 111 patients. Results: Focusing on the 8 STOPP and 11 START criteria, there was a significant reduction in the proportion of patients with at least one STOPP error (17.5% to 9%, p = 0.04). However, the decrease in the percentage of patients with at least one START error was insignificant (24.6% to 20.7%, p = 0.24). Conclusion: By identifying problematic areas of prescribing and using targeted interventions, the proportion of STOPP errors made in clinical decision unit reduced significantly. This study highlights the prevalence of prescription errors in the clinical decision unit and the impact of using screening tools to reduce incorrect prescribing.

Background Literature on bone marrow carcinomatosis in head and neck squamous cell carcinoma (HNSCC) is sparse. This work aims to augment understanding on its characteristic features, clinical presentation, investigations, treatment and outcomes. Methods Comprehensive literature review of all published cases of metastasis of HNSCC to the bone marrow with regard to clinical presentation, diagnosis, treatment and survival outcomes of this disease. Each of these factors is discussed forming an up‐to‐date review on the subject. Results Eight case reports were identified, seven males and one female with an age range of 35‒64 years. Primary sites were from the oral cavity (n = 4), oropharynx (n = 3) and supraglottis (n = 1). Six were stage four disease with nodal involvement, one case stage two and one case with unknown staging. Two of the oropharyngeal cancers were p16 positive, and one p16 status was not documented. Five patients presented with back pain, two patients had ecchymoses with bleeding, and one presented with sepsis and thrombocytopaenia. Three patients had proven disseminated intravascular coagulation. Four patients were treated with palliative chemoradiotherapy, one had palliative radiotherapy, one had radiotherapy and dendritic cell vaccine immunotherapy, and two died from the disease prior to any treatment. Various facets of presentation and management are discussed. Conclusion Bone marrow carcinomatosis from HNSCC is rare. It can present with a variety of non‐specific symptoms, and a high index of suspicion is required to be able to diagnose the condition promptly. Aggressive chemotherapy is the treatment of choice but prognosis remains poor.