Polypharmacy and deprescribing

Appropriate polypharmacy and deprescribing has long been a popular topic with both commissioners and patient facing clinicians and is a priority for PrescQIPP in order to help improve patient safety.

This webkit outlines the work that we have done to support this important area of Medicines Optimisation.

This webkit brings together all the PrescQIPP Polypharmacy and Deprescribing (P&D) resources and showcases good practice examples of projects focusing on medicines optimisation, medication review and appropriate polypharmacy gathered nationally and internationally.

Additional resources include algorithms to support the deprescribing of specific medicines, flow chart, case study and patient letter.

Why not add to the resource by contributing your local work?

Ensuring appropriate polypharmacy - Flowchart

The flowchart shows the steps in the process to engage patients fully in decisions about their treatment.

Medication reviews

To ensure a reduction in potentially inappropriate (problematic) polypharmacy it is essential that regular, effective medication reviews are undertaken, particularly for vulnerable people, e.g. those with changing frailty.

There are many patients who need a full medication review, but there are limited resources to undertake these. This section offers guidance on: how to offer an effective medication review, prioritising your patients, suggestions for who can undertake a medication review, how to engage patients and a discussion on the ideal consultation length. Validated tools to support a medication review, and the NO TEARS adapted tool are also described.

B254: Polypharmacy and deprescribing

Two new polypharmacy and deprescribing bulletins are available.

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B184: Behaviour change strategies

This bulletin introduces some of the key concepts around behaviour change and considers practical ways in which health professionals can use and develop their skills.

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B152: Improving medicines and polypharmacy appropriateness clinical tool (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.

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High risk medicines

The PrescQIPP IMPACT tool and the 254. Polypharmacy and deprescribing II identify some high risk medicines which it would be appropriate to prioritise for medication review. The materials below help support appropriate identification and review of patients taking these medicines.

B254: Polypharmacy and deprescribing

Two new polypharmacy and deprescribing bulletins are available.

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Antibacterials

Antibiotic resistance and the lack of new antibiotics being developed to replace ones for which resistance is a significant issue are still ongoing concerns. It is imperative that we do all that we can to preserve the usefulness of the antibiotics we currently have.

B253. Anticholinergic burden

This bulletin discusses the review of treatment with anticholinergic drugs and the different scales available to support review. Support materials are available to identify the risk in patients and support appropriate action to reduce anticholinergic burden.

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Anticholinergic burden e-learning course

Our Anticholinergic burden e-learning course is CPD certified and available to all NHS registered users and subscribers for free. This course is for medicines management teams, GPs, practice nurses, practice pharmacists and non-medical prescribers.

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B137: Constipation

The constipation bulletin reviews the treatments available for constipation (including newer therapies) and provides advice and guidance on when they should be used and for how long.

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B256: Dependence forming medications

The dependence forming medicines (DFMs) resources provide an overview of DFMs and signpost to PrescQIPP resources which support medicines optimisation projects in this area.

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B132: Fentanyl

Immediate release fentanyl has a NICE do not do as a first line treatment for breakthrough pain. This bulletin which is a DROP list support bulletin will focus on fentanyl immediate-release formulations and provide the rationale for new patients to be commenced on immediate-release morphine.

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B258: Hypnotics

This bulletin offers advice on managing new patients with insomnia, recommends cost-effective prescribing choices, and encourages you to review chronic hypnotic users with a view to helping them withdraw from treatment.

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B152: Improving medicines and polypharmacy appropriateness clinical tool (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.

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B252: Medicines without harm

These resources support the implementation of local campaigns for the World Health Organisation (WHO) global patient safety challenge, medication without harm.

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B265: NSAIDs

These resources look at the safety implications of long term treatment with NSAIDs and support treatment initiation and review.

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B80: Opioid patches

The opioid patches bulletin focuses on the safe and appropriate prescribing of opioid patches as well as cost effective treatment choices. An audit is available to help support the review of patients already prescribed opioid patches to assess whether there is a continued need for treatment with patches.

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B56: Oxycodone/naloxone prolonged release (Targinact ®) tablets

The bulletin and resources provide further information on the evidence base for for using oxycodone/naloxone prolonged release tablets, the rationale to stop treatment and also suggests alternative treatment options.

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B267: PPI- Long term safety and gastroprotection

This bulletin and implementation resources focus on reducing PPI prescribing for safety reasons by reviewing the continued need and stepping down or deprescribing where appropriate in line with current guidance.

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Reducing antipsychotic use in dementia

The PrescQIPP reducing antipsychotic prescribing in dementia toolkit is a resource aimed at healthcare professionals and carers, which can be used to support these symptoms without the use of antipsychotics.

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Reducing antipsychotics in dementia webinar

In this webinar, Cherise Howson and Sajida Khatri showcase the resources in the reducing antipsychotics in dementia toolkit and discussed the evidence behind the recommendations.

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B62: Tramacet®

This bulletin focuses on Tramacet® (paracetamol 325mg/tramadol 37.5mg) and provides the rationale for new patients to be initiated on paracetamol or paracetamol with codeine. Current patients should be considered for a switch to paracetamol alone or paracetamol with codeine.

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Webinars

Polypharmacy and deprescribing e-learning course

Two CPD accredited Polypharmacy and Deprescribing e-learning courses are available from PrescQIPP.  A concise course is available for GPs and other experienced healthcare practitioners with some experience of the subject. A full length more comprehensive version of this course for trainee GPs and non-medical prescribers is also available.

The e-learning packages are free to access by five members of the subscriber medicines management teams only using a special promo code. If you are a member of a medicines management team, please contact your subscriber lead for details.

Access for other healthcare professionals including practice staff can be purchased either by the CCG/Health Board as a bolt on to subscription (for more information, please email elearning@prescqipp.info, or directly via PayPal by individual users for £12.50.

Access the polypharmacy and deprescribing e-learning course here.

Shared good practice - Award winning project webinars

Shared good practice - Other projects

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