PrescQIPP

Assessing the impact of an educational intervention on ACB scores (2025)

Berkshire Primary Care - Clinical Pharmacy Team

Project summary

The risk of cognitive impairment in older people can be increased by medications with a high ACB score. These medications are also associated with an increased risk of dementia and death in older adults. Pharmacists play a key role in deprescribing of anticholinergic medication through structured medication reviews. It was recognised that there was a lack of confidence within the pharmacy team in how to tackle deprescribing of ACB medication.

Our frailty pharmacist prepared and delivered a "ACB masterclass" for the pharmacy team which comprises clinical pharmacists, pharmacy technicians, trainee pharmacists and pharmacy students with the aim of improving confidence in ACB deprescribing, improving scoring of ACB during SMRS and actually reducing ACB scores. .

The impact of the educational event on the pharmacy team was measured using questionnaires before and after the masterclass. There was a significant improvement in both confidence and competence from attendees. 
In addition we were able to demonstrate a 60% increase in ACB score documentation during SMRs before and after training and a reduction in ACB score from 3.7 to 2.3 due to deprescribing. This was measured using a randomised sample of SMRs completed before and after the educational event in Ascot PCN practices.

This project successfully integrated ACB awareness and deprescribing strategies withing SMRs, improving patient care and pharmacists' confidence.

The team has become more aware of the risks associated with ACB for patients taking multiple drugs with a total score of 3 or higher. They are now more confident in explaining ACB to patients and its impact on their health. ACB score are routinely calculated for each patient’s SMR. The team works collaboratively, seeing support and advice for complex cases and having the option to refer or discuss in pharmacy clinical meetings.

Lessons learned include the importance of team collaboration, structured planning, and utilising available resources efficiently (e.g.: PreSquipp searches).