Prevention of Hospital‐Acquired Adverse Drug Reactions in Older People Using Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A Cluster Randomized Controlled Trial

Objectives To determine whether use of the Screening Tool of Older Persons' Prescriptions ( STOPP ) and Screening Tool to Alert to Right Treatment ( START ) criteria reduces incident hospital‐acquired adverse drug reactions ( ADR s), 28‐day medication costs, and median length of hospital stay in older adults admitted with acute illness. Design Single‐blind cluster randomized controlled trial ( RCT ) of unselected older adults hospitalized over a 13‐month period. Setting Tertiary referral hospital in southern Ireland. Participants Consecutively admitted individuals aged 65 and older (N = 732). Intervention Single time point presentation to attending physicians of potentially inappropriate medications according to the STOPP / START criteria. Measurements The primary outcome was the proportion of participants experiencing one or more ADR s during the index hospitalization. Secondary outcomes were median length of stay ( LOS ) and 28‐day total medication cost. Results One or more ADR s occurred in 78 of the 372 control participants (21.0%; median age 78, interquartile range ( IQR ) 72–84) and in 42 of the 360 intervention participants (11.7%; median age 80, IQR 73–85) (absolute risk reduction = 9.3%, number needed to treat = 11). The median LOS in the hospital was 8 days ( IQR 4–14 days) in both groups. At discharge, median medication cost was significantly lower in the intervention group (€73.16, IQR €38.68–121.72) than in the control group (€90.62, IQR €49.38–162.53) (Wilcoxon rank test Z statistic = −3.274, P  < .001). Conclusion Application of STOPP / START criteria resulted in significant reductions in ADR incidence and medication costs in acutely ill older adults but did not affect median LOS .