3215 Reducing anticholinergic burden (ACB) within the healthcare for older people's (HCOP) wards

Abstract

Introduction Medications with anticholinergic properties can have significant adverse effects, particularly in older adults. An Anticholinergic Burden (ACB) score of ≥3 is associated with increased risks of falls, cognitive impairment, and mortality. Additionally, side effects such as urinary retention, visual disturbances, and constipation are frequent contributors to delirium. Aim To assess whether raising awareness of ACB within the Healthcare of Older People (HCOP) department can lead to a reduction in ACB scores. Methods Over four months, a teaching session and a poster was disseminated on ACB. Retrospective data were collected from three separate weeks, one before any intervention, one after the teaching session and one after the poster for patients discharged from the HCOP department. Admission and discharge ACB scores were calculated using the ACB Calculator (www.acbcalc.com). Patients on end-of-life medications were excluded. Results Cycle 1: Of 40 patients, 13 had an ACB score ≥ 3 on discharge. Seven patients retained their admission ACB scores ≥3 at discharge, while eight patients showed a reduction. A lack of awareness of ACB was identified, prompting a teaching session. Cycle 2: Of 33 patients, eight had an ACB score ≥ 3 on discharge, and 11 showed a reduction in scores. A poster campaign was launched across HCOP doctors’ offices. Cycle 3: Among 39 patients, 17 had an ACB score ≥ 3 on discharge. However, this cycle achieved the highest number of score reductions, with 12 patients showing improvement. A side analysis revealed that lansoprazole was the most commonly prescribed medication with anticholinergic properties, affecting 33 patients across the three cycles. Conclusion Raising awareness of ACB scores has successfully reduced ACB scores. Sustained efforts, including regular reminders and medication reviews, are essential to mitigate risks for older patients. Ongoing discussions with the pharmacy team aim to implement an automated ACB score calculation in the online noting system.