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Geriatric analgesia 45
combined with NSAIDs such as ibuprofen. 16 The NSAIDs are not the only
analgesic implicated in warfarin–analgesia interaction: there is debate over
whether warfarin’s effects are potentiated by acetaminophen (paracetamol). 17
Since it is impossible to remember every potential drug–drug interaction
involving analgesics, it is prudent not only to be cautious with starting dosages
of analgesia, but also to ask pharmacists to assist with recommendations on
both dosage and on how to avoid potential or real drug interactions.
An adverse drug event is any complication stemming from the use of a
medication. This umbrella, therefore includes expected drug side effects as
well as drug sequelae occurring owing to inappropriate dosing or administration.
Adverse drug events are a major problem, constituting the most common
type of adverse event in the overall hospital population; older patients are
much more likely than younger adults to suffer such adverse drug events. 18,19
Education and awareness of the issues are useful steps, but ultimately the
reduction of error in geriatric analgesia usage requires both system and
personnel contributions including decision support-aided computerized
physician order entry, unit dose drug distribution, ED pharmacist availability,
patient counseling, and protocols for the use of high-risk drugs. 20
n Beers criteria: a practical tool to enhance
safety in geriatric analgesia
To help in avoiding error, the Beers criteria were developed. These evidencebased
guidelines, generated by a multispecialty panel using a modified
Delphi approach, were initially developed to enhance safe prescribing of
medications to nursing home patients. 21 The Beers criteria have been adopted
by many healthcare authorities, including the Centers for Medicare and
Medicaid Services, and are now the most often-used consensus criteria
guiding medication use in older adults. 22,23
There are no geriatric drug use guidelines designed expressly for the acute
care setting. Consequently, the widespread acceptance and demonstrated
utility of the Beers criteria in a variety of healthcare settings (i.e. in addition to
nursing homes) constitute reasonable basis for their application to geriatric
ED patients. 23,24 Selected recommendations are presented in the table. 24