Prescribing and medication management

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Poster ID
1156
Authors' names
W Kirk; R Mizoguchi; I Safiulova; D Dede; Z Yeo; J Bailey; S Robertson; L Karran
Author's provenances
Chelsea and Westminster Hospital

Abstract

Introduction Polypharmacy is an increasing concern in medicine which will lead to prescribing errors, serious drug interactions and potentially inappropriate prescribing. Aim To improve recognition of ‘Polypharmacy’, routine medication reviews during patient admissions and better communication and awareness of ‘Polypharmacy’ to General Practitioners (GP). Methods This audit consisted of two cycles both performed over 6 weeks. Inclusion criteria: patients aged 65 < and on 6 < medications, admitted to Elderly Care ward at Chelsea and Westminster hospital. Interventions after the first cycle included education such as encouragement of clear documentation in medical record and GP summary, introduction of medication reviews as part of ward round, collaborative work with pharmacists. In the second cycle Potentially Inappropriate Medications (PIMS) were assessed using the STOPP/ START criteria approved by NICE guideline has been used to review medication regimes and highlights PIMS. Results First cycle 30 patients were recruited with an average age of 79.2 (13males and 17 females). An average number of PIMS at the time of admission was 1.3 and 0.5 on discharge. Only 1/30 (3.3%) has ‘Polypharmacy’ documented and medication reviewed; Medications Reconciliation was 29/30 (96.7%). None of the patient has documentation for Polypharmacy. Second cycle 29 patients were recruited with and average age of 80.1. (7 males and 22 females). PIMs on admission was 1.3 and 0.3 on discharge. 25/29 (86.2%) patients had ‘Polypharmacy being documented and Medication review for 29/29(100%). Medication Reconciliation was 29/29(100%). Most Common PIMS across both cycles were statins, antihypertensive and Proton Pump Inhibitor. Conclusion The interventions complete improved significantly the awareness of Polypharmacy. There is a significant increment in number of medication review of 96.7% and 82.9% on documentation for ‘Polypharmacy’, and 20% reductions in PIMS on discharge.

Poster ID
1366
Authors' names
Hannah Stonehouse, James Warne, Ewan Tevendale
Author's provenances
Darlington Memorial Hospital, DL3 6HX

Abstract

Background Polypharmacy is a recognised burden on patients with frailty. Medication reviews as part of comprehensive geriatric assessment (CGA) ensure appropriate prescribing and minimise harms. This project aimed to develop and initiate a pharmacist delivered frailty medication review tool to enhance existing CGA within our acute frailty service. Methods A structured in-patient medication review tool was developed based on the STOPIT and STOPPFRAIL tools for patients with a clinical frailty score (CFS) of >4. Initial work tested this on 20 patients in our frailty ward evaluating usability and efficacy. A sample of patients seen by the acute frailty team were audited against this tool. Data was collected on falls risk medications, Anticholinergic Burden (ACB), medications stopped, medications to review and cost savings. On identifying the potential benefits, this tool was trialled by pharmacists on all elderly care wards with similar outcomes collected. Results. Twelve acute frailty inpatients’ CGAs were audited against the tool. Five had some evidence of a polypharmacy review but no FRAX or ACB scores were completed. 58% of patients were on 3 or more 'falls medications. Overall, 19 medications should have been stopped, 5 medications could have been reduced and 14 medications highlighted for review in primary care, with a potential cost saving of £956.35/year. After initiating pharmacist reviews with the tool, 34 of 34 patients had a review, 80% of FRAX scores were documented, ACB score was completed for all patients. All patients were taking medications that increased risk of falls (average 3.5/patient) with 16 patients on ≥4. Eighty-five medications were stopped, 10 medications reduced and 33 medications highlighted for review in primary care, with a cost saving of £2755.29/year. Conclusions This project developed a pharmacist delivered acute frailty polypharmacy tool which enhanced existing frailty medication reviews with potential cost savings.

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