Indicators of prescribing quality for elderly hospital inpatients

Objectives: To develop a set of indicators of prescribing quality for elderly patients in Australian hospitals. Methods: Based on a set of indicators developed in the UK, indicators were developed and piloted at nine hospitals in Victoria. Indicators fell into three groups: a) summarising general prescribing activity, b) assessing prescribing based on prescription data only, and c) assessing prescribing based on prescription and clinical data. Following pilot audits, the indicators were reviewed, and indicators that were impractical or flawed were dropped. To assess inter-rater reliability, a selection of prescriptions were assessed by two pharmacists. Audit results for three indicators were fed back to participating hospitals at meetings attended by medical, nursing and pharmacy staff, and also in writing. To evaluate hospital staff perceptions of the audits and feedback of audit results, a questionnaire was sent to staff at six hospitals. Results: Twenty-four indicators were developed and applied to prescriptions for 1416 patients. Following pilot audits, review of the indicators resulted in deletion of five, resulting in a final set of 19 indicators. For prescriptions reviewed by two pharmacists (n = 66), assessment agreed in 85% of cases (Κ = 0.7), indicating good inter-rater reliability. Responses to the questionnaire (n = 22, 20%) were positive. All respondents felt that audit and multidisciplinary feedback using the indicators had raised awareness amongst the prescribing team regarding the topics presented, and 77% felt it would result in better prescribing. Conclusion: Nineteen indicators were developed to objectively and reliably assess, monitor, benchmark and improve prescribing for elderly hospital inpatients.