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Abstract Introduction: Polypharmacy and inappropriate medication are common issues in elderly patients. Older people are more likely to suffer from adverse drug reactions and other drug-related problems due to the increased presence of multimorbidity, inappropriate polypharmacy, age related impairments in the hepatic metabolism and renal clearance of medication and enhanced pharmacodynamic sensitivity to specific drugs. Aim: The aim of this study was to analyze, compare and describe medication use in the MedBridge study population, in total and for different patient groups. Materials and Methods: Medication data from approximately 700 patients from Uppsala University Hospital and the hospital of Enköping was extracted from the medical record system and stored in an electronic data capture system. This data was joined together with the collected data from the other 1939 study participants and exported to Microsoft excel for analyses. Results: The mean value of prescribed medicines was 9.2. Women had significantly higher (p<0.05) number of prescribed medicines. Participants aged 85 or older had the highest number of prescribed medicines and participant between 65-74 had the least prescribed medicines. The mean value was significantly higher (p<0.05) for women aged 85 years or older and women between 75-85 years compared with women aged 65- 74. In this population 461 patients (17.4%) used at least one inappropriate medicine. Of all the women 18.8% used at least one inappropriate medicine and 15.7% of all the men. Women aged 85 years or older used the most inappropriate medicines and men between 65-74 used the least. Women aged 85 or older used significantly (p<0.05) higher amount of inappropriate medicines than women aged 65-74 years did. Conclusion: In conclusion, this report shows that many of our elderly haves’ polypharmacy and that women are using more medicines than men and more inappropriate medicines than men. It also indicates that the older you get, the more medicines you use.

Introduktion: Det finns många fördelar med parenteral administrering, exempelvis ger det hög biotillgänglighet och snabb systemisk insättning. Men eftersom kroppens naturliga försvarsbarriärer förbigås kan kontaminerade parenterala läkemedel leda till allvarlig patientskada eller i värsta fall död. För att undvika detta är det viktigt att personalen som iordningställer de parenterala läkemedlen arbetar aseptiskt. Syfte: Att utreda skillnader i säkerhet och kvalité vid iordningställande av parenterala läkemedel när det utförs av sjuksköterskor jämfört med farmaceuter. Metod: En observationsmall utformades innehållande sex olika parametrar som ansågs mäta säkerhet och kvalité vid iordningställande av parenterala läkemedel. Observationsmallen användes för observation av sjuksköterskor och farmaceuter när de iordningställde parenterala läkemedel på fyra olika avdelningar på Akademiska sjukhuset. Statistisk analys utfördes med Pearson´s Chi2-test. P-värden under 0,05 ansågs vara signifikanta. Resultat: Totalt observerades 276 iordningställanden av parenterala läkemedel utförda av 14 sjuksköterskor och 3 farmaceuter. Farmaceuterna utförde fem av de sex parametrarna signifikant fler gånger (p<0,0001) än sjuksköterskorna, med ett genomsnitt på 31,2 procentenheter högre. Det fanns även signifikanta skillnader inom samma yrke. Slutsats: Dessa resultat tyder på att kvalitén och säkerheten är beroende av vilken personal som iordningställer. Vad dessa skillnader beror på kan inte fastställas utifrån denna undersökning. Att farmaceuter fick bättre resultat kan bero på deras breda läkemedelskunskaper, men det går inte att utesluta andra anledningar. Andra faktorer som kan spelat in är de olika typerna av arbetssätt samt vilken typ av avdelning de arbetade på. För att säkerställa dessa resultat bör en mer omfattande studie genomföras med fler observerad personal.

External validation of a tool to assess medication-related admissions in four Swedish hospitals Background The MedBridge trial is a large ongoing clinical trial on medication reviews in elderly patients in Sweden with participating hospitals from Uppsala, Enköping, Västerås and Gävle. A tool for assessing medication-related admissions (MRAs) has been developed and validated in Uppsala: Assessment Tool for identifying Hospital Admissions Related to Medications (AT-HARM10). MRAs is often used as an outcome for medication reviews and similar interventions. Validation of AT-HARM10 outside of Uppsala is therefore warranted. Aim The aim was to externally validate AT-HARM10. This was needed since AT-HARM10 was for the first time used outside Uppsala. Materials and methods The readmissions of elderly patients within the MedBridge trial were collected from all participating hospitals. The assessors in this study were two final-year pharmacy students. First, the assessors assessed the readmissions independently of each other and then a consensus meeting was held where the readmissions were discussed, and a consensus was reached. The outcomes in this study were the assessment time, inter-rater reliability and content validity between the hospitals from Uppsala, Enköping, Västerås, and Gävle. The time was measured every day during the assessment period. The inter-rater reliability was calculated for every consensus meeting. The content validity was based on the questions from AT-HARM10 and was collected for each of the assessed readmissions and compared between the four participating hospitals. The content validity of the distribution of questions U1-P10 between the hospitals was tested with a χ2-test. Results In this study, 1687 unplanned readmissions from 893 patients were assessed. Uppsala University Hospital had 6.6 minutes as total mean assessment time including consensus meeting. The total mean time from Enköping, Västerås and Gävle were 6.48, 6.32 and 6.16 minutes respectively. The strength of agreement between the two assessors was substantial in Uppsala, Västerås and Gävle (ĸ 0.80, 0.79 and 0.76 respectively) and perfect in Enköping (ĸ 0.89). For the content validity were there no differences between the hospitals in the distribution of question U1-P10. Conclusion AT-HARM10 was for the first time used outside Uppsala and has been externally validated with data from the hospitals in Enköping, Västerås, and Gävle. The time needed per admission for the two assessors was low which confirms that it is possible to have final-year pharmacy students as assessors. This information is important both within the MedBridge trial and if the tool would be used in outer clinical studies.

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