Bulletin 152: Polypharmacy - IMPACT

In 2011 PrescQIPP launched the Optimising Safe and Appropriate Medicines Use (OSAMU) Guidance: a pragmatic, evidence-based resource designed to be used in conjunction with other relevant, patient specific information. This was updated in 2016 to Improving Medicines and Polypharmacy Appropriateness Clinical Tool (IMPACT). Sectioned into BNF chapters, it identifies clinical and cost benefits with recommendations and considerations for appropriately continuing or stopping medicines. The document was originally produced as a PrescQIPP bulletin following a literature review which found little evidence about the practicalities of stopping medicines but large numbers of tools for reviewing potentially inappropriate medicines and various papers advocating the positive impact of stopping medicines if no clinical need exists.

The original OSAMU document was used by GPs, pharmacists and geriatricians during medication reviews in care homes, conducting collaborative discussions with the patient, nurse and GP. It was used in eight care homes during 235 multidisciplinary medication reviews and resulted in the safe and appropriate discontinuation of 398 medicines and ensured patients were prescribed the essential medicines they required. It is an education tool and provides a reference source for clinicians. Reported outcomes included: reduced polypharmacy, potential interactions and adverse effects, reduced medicine administration time and consequently increased time for patient care, reduced medicine waste and costs and reduction in the overall number of medicines taken, which was welcomed by patients.