19 | Pilot project of medication review and deprescribing dedicated to the care of elderly patients on polypharmacy who access in the emergency department for acute kidney injury and hydro-electrolyte imbalances.

G. Coniglio, A. Panico, F. Liccardi | AORN Antonio Cardarelli, Napoli.

Introduction. It has been demonstrated that the incidence of adverse drug reactions and many hospital admissions in the elderly population are related to medications taken.

Objectives. We implemented a medication review and deprescribing intervention in elderlys on polypharmacy who presented to the Emergency Department (ED) with acute kidney injury and electrolyte imbalances. The endpoints of this project were to assess that clinical data could be linked to drug interactions in home medications; to reduce hospital stay duration; to decrease the risk of readmissions within three months.

Materials and Methods. Data were collected between March and May 2025 from 10 patients over 65 years who takes polypharmacy and presented to the ED with an increasing serum creatinine; hypo or hypernatremia; hypo or hyperkalemia. We applied a simplified Comprehensive Geriatric Assessment including Clinical Frailty Scale, Activities of Daily Living, Instrumental Activities of Daily Living and Gerontonet Risk Score. The intervention was divided into reconciliation and verification, in which geriatrician and hospital pharmacologist jointly evaluated potential adverse reactions with dedicated tools, Beers and STOPP/START Criteria. Three-month follow-up were performed via interviews to track any hospital readmissions.

Results. In most analyzed cases, there was a strong correlation between the clinical condition leading to ED observation and home polypharmacy. Most of the patients had a moderate frailty, with high risk of adverse events. This diagnostic evaluation has halved the time spent in the ED, except for cases of hypo and hyperkalaemia. At three-month follow-up, six patients vs. four were not readmitted within three months.

Conclusions. The analyzed cases showed a reducing dialysis risk with shorten hospital stays for electrolyte disorders. We also observed that a rapid medication washout could markedly improve health outcomes, shortening hospital stays by 48–72 hours and avoiding overtreatment.