351 Detectability of medication errors in older people prior to potentially preventable admissions Introduction Reducing drug-related harm is a continuous challenge for health care professionals who aim to maintain a positive benefit-risk balance of pharmacotherapy to treat patients [1–3]. With ageing, the susceptibility to develop chronic diseases and multimorbidity – the co-existence of multiple chronic diseases in an individual – increases [4–6]. Multimorbidity impacts the quality of life and frequently results in polypharmacy [7,8], usually defined as the concomitant use of five or more regularly prescribed medications [9,10]. Multimorbidity and polypharmacy are both important risk factors for drug-related hospital admissions (DRAs) [11,12]. A DRA is defined as ‘a hospitalisation due to an adverse drug event (ADE); harm due to an adverse drug reaction (ADR) or a medication error (ME) related to overuse, underuse, or misuse of prescription and non-prescription medications and which is the main reason for or contributes to hospital admission of a patient’ [13]. DRAs caused by MEs are of particular interest, because they are potentially preventable [14–17]. Older people are four times more likely to be admitted due to drug-related problems than younger adults [18,19]. It is estimated that DRAs account for 10–30% of all acute hospital admissions in older people, and about half of these are considered potentially preventable [19–25]. Similarly, the risk of drug-related readmissions is high in older people with an estimated incidence of 21% (IQR 14–23), although reported incidences vary greatly among studies due to heterogeneity in definitions and study populations [11,12,26]. Hence, effective strategies to reduce preventable DRAs in this population are urgently needed. Several explicit screening tools have been developed to facilitate the detection of potential MEs in medication review in older people [27]. The Screening Tool of Older Person’s Prescriptions and the Screening Tool to Alert doctors to Right Treatment (STOPP/START) criteria are the most widely used explicit screening tools in Europe, and their use in older patients has proven to decrease potential medication overuse, underuse and misuse [27–31]. In addition, the use of clinical decision support systems (CDSS) demonstrated a reduction in potentially inappropriate medication in hospitalised older adults [32,33]. A CDSS-assisted structured medication reviewwith integrated STOPP/START algorithms may contribute to reducing MEs that lead to potentially preventable DRAs [34]. Hence, the STOPP/START criteria version 2 were converted to software algorithms to enable their incorporation into a CDSS [35,36]. The effect of a CDSS-assisted STOPP/START-based medication review in hospitalised older people with polypharmacy and multimorbidity was recently investigated in the OPtimising thERapy to Prevent Avoidable Hospital Admissions in the Multimorbid Elderly (OPERAM) trial [37,38]. The primary outcome of this multicentre randomised controlled trial was the occurrence of a first DRA within one year after receiving 4
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