Appropriate Polypharmacy and deprescribing has long been a topic which is very popular with Commissioners, and of great importance to PrescQIPP to ensure patient safety. This webkit outlines the work that we have done so far, and the work that we’re looking to do to support this prominent area of Medicines Optimisation. Please find a range of information, resources and ideas for this key area. Why not add to the resource by contributing your local work?
Polypharmacy and Deprescribing - Appropriate Polypharmacy
This webkit will gradually bring together all the PrescQIPP Polypharmacy and Deprescribing (P&D) resources and showcase good practice examples of projects focusing on medicines optimisation, medication review and appropriate polypharmacy gathered nationally and internationally. Some resources contain tools and templates that can be adapted for local use and implementation.
Polypharmacy has been recognised and discussed for decades, but little has changed and patients are still prescribed many medicines on a continuing basis, often with insufficient or no reviews. This is a complicated area, some polypharmacy is appropriate, recent studies have shown that multiple prescribing does not always result in poor quality prescribing. However, it is known that some polypharmacy is potentially problematic and for this cohort of patients practice needs to change. Action is needed now to ensure patient safety and the reduction of waste leading to the consequent savings available to the NHS.
See our workplan for information on our polypharmacy planned work.
Multimorbidity and Frailty
Polypharmacy can play an important role in increasing a person’s life expectancy and quality of life, however this needs to be balanced with any potential harms of medicines and the risks of non-adherence. It is essential to optimise medicines to ensure safe prescribing and appropriate polypharmacy for patients with multimorbidity as well as increasing frailty or those moving towards end of life.
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.
High Risk Medicines
The PrescQIPP IMPACT project and the medication review documentation identifies some high risk medicines which it would be appropriate to prioritise for medication review. The materials in the sliders below help support appropriate identification and review of patients taking these medicines.
Links to other PrescQIPP webkits which support medication review
Below we have linked to other PrescQIPP webkits, which have useful resources within them and tools, which can support medication review in appropriate patients.
Education Package for Healthcare Professionals
The concept of deprescribing is still new to many clinicians and this course explains the principles as well as practical advice as to how it can be undertaken. It has been designed for all clinical staff who are involved in the prescribing and review of medicines, including: pharmacists and pharmacy technicians within medicines management teams; practice pharmacists; nurses; and GPs. These resources have been developed to support face to face training that can be delivered in modules/ bite sized chunks.
Sharing Polypharmacy and Deprescribing Resources
PrescQIPP supports innovation and sharing of resources to avoid duplication and to speed up the delivery of ideas.
The examples listed here have not been validated by PrescQIPP through the usual QA process as they have been provided directly from organisations. If you want to use anything listed please acknowledge the original source in your locally adapted work.
If you would like to contribute your own examples please forward them, with a contact, to email@example.com