Anticholinergic Burden Scoring in Orthogeriatric Patients: A Two-Cycle Quality Improvement Audit

Background: Anticholinergic burden is relevant to medication review in older surgical patients, but routine documentation may be incomplete.Objective: The objective of this study is to compare documented Anticholinergic Cognitive Burden (ACB) assessment before and after a multicomponent quality-improvement intervention.Methods: This single-centre retrospective quality-improvement audit compared two independent cohorts of surgical patients aged ≥65 years in June 2023 and April 2024.Staff education, posters, and a proforma incorporating ACB and medication-review prompts were introduced between cycles.Process outcomes were compared using Fisher's exact test.The pooled cross-sectional association between ACB and the composite cognitive-screen outcome was exploratory and unadjusted.Results: Seventy-two patients were included: 33 at baseline and 39 at re-audit.ACB documentation increased from 0/33 (0.0%) to 15/39 (38.5%), an absolute increase of 38.46 percentage points (95% CI 21.35-54.10;p<0.001).Documented medication review increased from 1/33 (3.0%) to 19/39 (48.7%; p<0.001), and documented medication modification from 1/33 (3.0%) to 10/39 (25.6%; p=0.009).ACB-category distributions did not differ significantly (p=0.910).The composite cognitive outcome was present in 16/25 (64.0%) patients with ACB ≥2 and 7/47 (14.9%) with ACB 0-1, corresponding to an unadjusted prevalence ratio of 4.30 (95% CI 2.04-9.04).This association was limited by the small sample, different preoperative cognitive instruments, and absence of confounder adjustment.Conclusion: Documented ACB assessment and medication-review processes increased between cycles, but implementation remained incomplete.A reduction in medication burden or improvement in patient-centred outcomes was not established.