Improving quantification of anticholinergic burden using the Anticholinergic Effect on Cognition Scale – a healthcare improvement study in a geriatric ward setting

Balasundaram, Bharathi; Ang, Wendy Swee Tee; Stewart, Robert; Bishara, Delia; Ooi, Chun How; Li, Fuyin; Akram, Farooq; Kwek, Andrew

doi:10.1177/10398562221103117

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…Although there was no criterion standard to assess the anticholinergic burden, the Anticholinergic Burden Scale (ACB) was quantified as the cumulative effect of anticholinergic activities using the ACB by Rudolph et al 22,23 Although there exist various scales designed to assess anticholinergic burden, we specifically opted for the scale by Rudolph et al because of its focus on measuring the risk of anticholinergic adverse effects. Some tools primarily evaluate anticholinergic cognitive burden, [24][25][26][27] whereas others center around the Drug Burden Index-Anticholinergic component. [28][29][30] Considering our study's specific emphasis on evaluating the risk associated with anticholinergic adverse effects, the ABS (ACB by Rudolph et al) was deemed the most suitable choice.…”

Section: Methodsmentioning

confidence: 99%

Call for Manuscripts

2023

Dimens Crit Care Nurs

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Section: Methodsmentioning

confidence: 99%

Call for Manuscripts

2023

Dimens Crit Care Nurs

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“…The current study builds on our earlier study on the measured anticholinergic burden in the geriatric psychiatry liaison service. 25 A baseline measurement that we undertook evaluated prevailing clinical practice for implementing improvements. In April 2022, we evaluated fifty consecutive liaison psychiatry assessments of older adults among referrals from geriatric wards through prospective data collection.…”

Section: Baseline Measurement (April To July 2022)mentioning

confidence: 99%

“…Embedding a Quality Framework for medication safety standards in delirium and dementia: A Singapore St… Delirium Communications psychotropic medications. The fourth safety standard reviewed measured anticholinergic burden using the Anticholinergic Effect on Cognition (AEC) scale, 25,27 a high burden defined as ≥3. Medichec, 27 an online resource, calculated anticholinergic burden scores and guided psychotropic medication prescribing decisions as a decision support tool.…”

Section: Pdsa and Strategy For Improvement (Supplementary Figure 2)mentioning

confidence: 99%

Embedding a Quality Framework for medication safety standards in delirium and dementia: A Singapore Study in a geriatric psychiatry liaison service

Balasundaram,

Loh,

Rosario

et al. 2023

Delirium Communications

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Introduction Research on prescribing processes for psychotropic medication review in older adult patients with severe behavioural symptoms of delirium and dementia appears limited. We aimed to improve and achieve 100% clinical documentation of psychotropic medication reviews against defined medication safety standards in older adult patients in geriatric wards with delirium occurrence and dementia without delirium referred to the geriatric psychiatry liaison service. The secondary aim evaluated any reduction in psychotropic medications as defined by medication safety standards by comparing pre-and post-assessments. Methods A baseline measurement in April 2022 showed no documentation records of the study’s first three standards. PDSA methodology was employed to evaluate whether a medication review occurred following the creation and implementation of medication safety standards 1 to 4 in cycle one and adding the fifth standard in cycle 2. The first, second and third standards were medication reviews of all hypnotics, antipsychotics, and psychotropic polypharmacy. The fourth standard reviewed the anticholinergic burden scores measured by the Anticholinergic Effect on Cognition scale. The fifth standard reviewed blood pressure and postural hypotension monitoring. Results Using a quality improvement framework that embeds defined medication safety standards as an intervention, we have demonstrated good documentation records for a medication review to improve psychotropic prescribing processes in the older adult’s psychiatry liaison service in geriatric wards in all standards in the 2 study cycles. There was a reduction in all psychotropic medications at post-assessment as defined by the medication safety standards 1 to 4 in at least one cycle in delirium occurrence and dementia without delirium, except for zopiclone in delirium. Conclusions The study’s findings in a geriatric ward setting in a public hospital in Singapore support the feasibility of embedding medication review using defined medication safety standards to improve psychotropic medication prescribing processes in older adults with delirium occurrence and dementia without delirium.

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