This post is for consultant pharmacists and clinical pharmacy directors who want a practical, evidence-informed refresher on the STOPP/START criteria and how to apply them during medication regimen review (MRR). You will get a clear explanation of what the tool is, how it differs from the Beers Criteria, and where it fits in your workflow. This is general professional education, not patient-specific clinical advice.
STOPP/START criteria explained: what the tool is
STOPP stands for Screening Tool of Older Persons' Prescriptions. START stands for Screening Tool to Alert to Right Treatment. Together they form a screening instrument developed by geriatricians and pharmacists in Europe to identify prescribing problems in older adults.
The two halves address opposite errors. STOPP flags potentially inappropriate medications (PIMs) that may cause harm and warrant review for deprescribing. START flags potential prescribing omissions (PPOs) — evidence-based therapies an older patient may be missing when a valid indication exists and no contraindication applies.
The criteria are organized by physiologic system and by mechanism, which mirrors how you already think during chart review. Each entry pairs a clinical scenario with a rationale so the consultant pharmacist can evaluate whether the flag applies to a given patient. The current widely referenced version is STOPP/START version 2; criteria are periodically revised, so confirm you are working from the most recent published edition.
How STOPP/START differs from the Beers Criteria
Both tools screen for inappropriate prescribing in older adults, and they overlap substantially. But they were built by different groups for somewhat different purposes, and using them together gives you a more complete picture than either alone.
- Origin and structure. The Beers Criteria are maintained by the American Geriatrics Society (AGS) and are widely used in U.S. practice. STOPP/START originated in Europe and is organized by physiologic system with explicit rationale statements.
- Omissions. Beers focuses primarily on medications to avoid or use with caution. START adds the dimension of undertreatment — therapies that may be missing. This is the most distinctive contribution of STOPP/START.
- Drug availability. Because the tools come from different regions, formulary and drug-name differences occasionally appear. Apply clinical judgment when mapping an entry to U.S. products.
The AGS Beers Criteria are published and updated periodically by the American Geriatrics Society; the STOPP/START criteria are published in the peer-reviewed geriatric literature. Always consult the authoritative, current source for the exact language and any updates before relying on a specific entry.
Where STOPP/START fits in medication regimen review
In skilled nursing and long-term care (SNF/LTC), medication regimen review is a recurring, regulated responsibility. STOPP/START gives you a systematic lens for two questions that matter in every review: what should potentially come off, and what might be missing.
A disciplined approach usually moves through a few stages:
- Assemble the full picture. Reconcile the active medication list against diagnoses, recent labs, renal and hepatic function, and functional status. STOPP/START flags depend on indication and context, not the drug name alone.
- Screen with STOPP. Identify medications that meet a potentially-inappropriate scenario — for example, therapeutic duplication, drugs that raise fall risk in patients with a history of falls, or agents that predictably worsen a coexisting condition. The consultant pharmacist evaluates whether the flag is clinically meaningful for this patient.
- Screen with START. Look for evidence-based omissions where a clear indication exists and no contraindication is documented. Undertreatment is easy to miss when review focuses only on what to stop.
- Cross-check with Beers and anticholinergic burden. Running complementary criteria reduces blind spots. Anticholinergic cognitive burden (ACB) scoring, in particular, surfaces cumulative anticholinergic exposure that single-drug screens can understate.
- Document rationale and recommend. Translate each finding into a concrete, defensible recommendation for the prescriber, with the clinical reasoning attached. The prescriber and the interdisciplinary team make the final decision.
Practical cautions when applying the criteria
Screening tools are decision support, not decision makers. A flag is a prompt to think, not a directive to act. Several cautions keep application safe and credible:
- Context governs everything. A medication that is potentially inappropriate for one patient may be entirely appropriate for another with a different indication, goal of care, or life expectancy.
- Deprescribing is a process. Stopping or tapering a chronic medication requires monitoring and prescriber collaboration. General principles do not replace an individualized plan built with the care team.
- Goals of care matter. In late-life and palliative contexts, the balance between benefit and burden shifts. START omissions may be intentional, and that intent should be documented.
- Criteria change. Because both STOPP/START and Beers are updated over time, working from an outdated version can produce misleading flags. Version control is a quality issue.
Turning findings into consistent, auditable recommendations
The clinical value of STOPP/START depends on consistency. If one reviewer catches an omission that another misses, or if the same scenario is documented three different ways, the program loses both clinical and survey credibility.
Standardizing how criteria are screened, how rationale is captured, and how recommendations are formatted makes your MRR program defensible. It also makes the work faster, because you spend your judgment on the patients who need it rather than on formatting and lookups. For a broader view of how structured review supports long-term care programs, see the WeConsultRx SNF and long-term care solution and the platform overview.
How WeConsultRx helps
The WeConsultRx clinical engine codifies 49 rules spanning Beers 2023, STOPP/START v2, and anticholinergic cognitive burden, so every medication regimen review is screened against the same criteria the same way — consistently, with the rationale attached and the final judgment left to you. Findings flow straight into consultant sign-off with e-signature and an append-only audit trail, giving your program clinical rigor and survey-ready documentation in one workflow. To see it applied to your setting, request a demo.