CPS1 – Side effects resulting in prescribing cascades

Linked to EAHP Statements

Section 1 – Introductory Statements and Governance: Statement 1.1
Section 4 – Clinical Pharmacy Services: Statements 4.1, 4.2, 4.3, 4.4, 4.5, 4.8
Section 5 – Patient Safety and Quality Assurance: Statements 5.1, 5.2, 5.5, 5.6, 5.8

ACPE UAN: 0475-0000-22-010-L05-P. A knowledge-based activity.

Abstract

The older population is increasing worldwide. This increases the number of patients with polypharmacy as well. From scientific literature, it is known that the risk for adverse drug events increases with every medicine that is prescribed. Prescribing cascades occur when an adverse drug event is misinterpreted as a new medical condition, resulting in the prescription of a potentially unnecessary drug to treat this new condition. Especially, in the older population, the recognition of adverse drug events is difficult as ageing can mask drug-related adverse events, and causes of new conditions (e.g. falls or delirium) become increasingly difficult to attribute to a combination of medication.

The phenomena prescribing cascades was first described in the Lancet and British Medical journal over 20 years ago. In the scientific literature, over 30 different prescribing cascades are described, showing that prescribing cascades do not only result in the prescription of an additional drug to treat the adverse drug event, but even in the use of medical devices (e.g. a pacemaker to treat bradycardia). Prescribing cascades are an important public health problem because they lead to adverse outcomes and unnecessary costs for the healthcare system, that can be avoided.

Hospital pharmacist could help in mitigating strategies for prescribing cascades by recognizing them, prevent them and reverse them. This seminar will provide an overview of different prescribing cascades and will provide strategies for hospital pharmacists to prevent, detect and reverse prescribing cascades in daily practice.

Learning objectives
After the session, participants should be able to:

• Understand important prescribing cascades;
• Understand how pharmacists could help in reversing or preventing prescribing cascades.

Educational need addressed
Clinical pharmacists perform medication reconciliation and medication reviews. This seminar will focus on the recognition of prescribing cascades that pharmacists could include in their medication reconciliation and medication review activities.

Keywords: Adverse drug reactions, counselling, drug use evaluation, interventions, medication safety.