J Heck1, A Ranker2,3, A Wranke4, L Kano5, C Macke2, J Rademacher6, D O Stichtenoth7, O Krause5,8. 1. Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland. Heck.johannes@mh-hannover.de. 2. Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland. 3. Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland. 4. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Deutschland. 5. Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland. 6. Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland. 7. Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland. 8. Zentrum für Medizin im Alter, DIAKOVERE Henriettenstift, Hannover, Deutschland.
Abstract
BACKGROUND: An orthogeriatric co-management can improve the quality of care for geriatric trauma patients. OBJECTIVE: The aim of this study was the establishment of treatment recommendations for the clinical routine in order to improve the quality of care for geriatric trauma patients. MATERIAL AND METHODS: Over a period of 7 months, 226 patients were discussed and visited once a week on 29 defined days, taking into account current laboratory results, vital signs, the medication as well as the clinical assessment by the nursing personnel. Besides physicians of different medical specialties (trauma surgery, geriatrics, clinical pharmacology, microbiology), members of the nursing staff and case managers took part in the ward rounds. RESULTS: On average, three treatment recommendations were made per patient visit (two pharmacological and one non-pharmacological recommendation [e.g. concerning fluid and delirium management]). The pharmacological and non-pharmacological recommendations were divided into several subcategories. The most frequent pharmacological recommendation was the discontinuation of a drug (30.4% of all pharmacological recommendations). CONCLUSION: The pharmacotherapy of geriatric patients requires careful consideration of contraindications, adverse drug reactions, duplicate medications, circadian aspects, and renal function. Regular re-evaluation of medical equipment can prevent catheter-associated infections. Identification and management of postoperative delirium is an integral component of the interdisciplinary orthogeriatric ward round. Evaluation of anti-infective treatment regimens with the expertise of a microbiologist/infectiologist proved to be very beneficial.
BACKGROUND: An orthogeriatric co-management can improve the quality of care for geriatric trauma patients. OBJECTIVE: The aim of this study was the establishment of treatment recommendations for the clinical routine in order to improve the quality of care for geriatric trauma patients. MATERIAL AND METHODS: Over a period of 7 months, 226 patients were discussed and visited once a week on 29 defined days, taking into account current laboratory results, vital signs, the medication as well as the clinical assessment by the nursing personnel. Besides physicians of different medical specialties (trauma surgery, geriatrics, clinical pharmacology, microbiology), members of the nursing staff and case managers took part in the ward rounds. RESULTS: On average, three treatment recommendations were made per patient visit (two pharmacological and one non-pharmacological recommendation [e.g. concerning fluid and delirium management]). The pharmacological and non-pharmacological recommendations were divided into several subcategories. The most frequent pharmacological recommendation was the discontinuation of a drug (30.4% of all pharmacological recommendations). CONCLUSION: The pharmacotherapy of geriatric patients requires careful consideration of contraindications, adverse drug reactions, duplicate medications, circadian aspects, and renal function. Regular re-evaluation of medical equipment can prevent catheter-associated infections. Identification and management of postoperative delirium is an integral component of the interdisciplinary orthogeriatric ward round. Evaluation of anti-infective treatment regimens with the expertise of a microbiologist/infectiologist proved to be very beneficial.
Entities:
Keywords:
Antimicrobial stewardship; Delirium; Drug therapy; Patient care; Trauma centers