Quality of Prescribing for Elderly Inpatients at Nine Hospitals in Victoria, Australia

Objective: To assess the quality of prescribing for elderly inpatients at nine acute and subacute public hospitals in Victoria, Australia. Method: Prescribing was assessed cross‐sectionally by reviewing prescriptions for all inpatients aged 65 years and over on participating units on the days of audit. Patients admitted less than 24 hours prior to audit were excluded. Evidence‐based prescribing indicators were used to assess quality of prescribing using patients' medication charts and hospital medical records. Results: Prescriptions for 1416 patients (median age 81 years, 57% female) were reviewed. The median number of medications prescribed was eight (0‐22). Thirty‐four per cent of items were prescribed by trade name; 37% of medication charts did not have patients' adverse drug reaction status recorded; 15% of ‘when required’ items had no frequency or maximum dose specified; 33% of sulphonylurea hypoglycaemic prescriptions were for long‐acting agents; 36% of paracetamol prescriptions allowed doses <4 g/day to be administered; 28% of allopurinol prescriptions were for doses ≥300 mg; 80% of benzodiazepine prescriptions and 32% of neuroleptic prescriptions were considered inappropriate; 48% of metformin prescriptions were for patients with renal impairment; 35% of patients with atrial fibrillation and no contraindication to warfarin or aspirin were not prescribed either of these drugs; and 26% of patients with ischaemic heart disease and no contraindication were not prescribed aspirin. Conclusion: A range of inappropriate prescribing practices for elderly hospital inpatients were identified. These included poor documentation, over‐prescribing, inappropriate drug selection, inappropriate dose selection, and under‐prescribing. Strategies are required to improve the quality of hospital prescribing.