The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications. Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely. To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Impact of an EMIS search to prioritise care home residents for a pharmacist led medication review, can be viewed here. For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

1. Findings : 286 reviews in 21/22 and 445 in 22/23
 21/22 Average number of interventions per review was 4.07 and in 22/23 this
figure was 4.52.
 21/22 Average number of drugs stopped per review was 1.46 with an average
saving of £86.19, and in 22/23 the figures were 1.30 with an average saving of
£86.15.
 21/22 Average number of hospital admissions avoided was 0.025 with an
average cost avoidance of £68.87, and in 22/23 the figures were 0.026 with an
average cost avoidance of £82.19
Background : I support 17 care homes across 3
PCNS, and their associated GP surgeries. There
are 710 beds across all the homes, and as such,
there was a need to prioritise those residents
most at risk of an ADR/hospital admission, for a
pharmacist led medication review. I developed
a search which could be imported into GP
systems on EMIS, which could be used to
identify those patients prescribed one or more
of a number of medicines linked to
ADRs/hospital admissions, as well as others
with limited clinical benefit (table 1). The
search was used to identify patients from April
2022 onwards.
Impact of an EMIS search to prioritise care home residents for a pharmacist led medication review. Faye Gallon, Care Home
Pharmacist, Coventry and Warwickshire ICB
Aim : Identify whether use of an EMIS search to prioritise residents most at risk of an
ADR/hospital admission, for a pharmacist led medication review, would result in
better outcomes for residents and the wider NHS system.
Discussion : See table 2. The number of reviews completed in 21/22 was much lower than the number
completed in 22/23. This may have been due to the ongoing COVID pandemic and a reduced capacity to carry
out reviews. Data was taken from MedOptimise, a system used to collate data from all reviews carried out,
and an average calculated for outcomes, given the difference in the number of reviews completed.
Following introduction of the EMIS search to prioritise residents for a pharmacist led medication review, the
number of interventions made per review was greater than the year previous. The number of drugs stopped
was lower per review in 22/23, however the average cost savings made were similar for both periods,
suggesting more expensive drugs were discontinued. The number of hospital admissions avoided per review
were similar year on year however the average cost avoidance was 19% higher, indicating more costly
hospital admissions were avoided. Use of the search also enabled residents who would most benefit from a
medication review, to be identified more effectively, removing the need to review all resident’s records
individually, to identify those most at risk of ADRs/hospital admission.
Conclusion : The use of a search to prioritise residents at high risk of ADR/hospital admission, for a pharmacist led medication review, did
not reduce the overall tablet burden for residents as fewer drugs were stopped, and it did not reduce the number of hospital admissions
avoided. However, it did result in greater savings per drug stopped and avoidance of more costly hospital admissions, with overall savings
of £74,919*, which benefits the GP practice, PCN and the wider NHS system. Use of the search also meant more effective use of time,
making the medication review process more efficient and equitable and has now been adopted by pharmacist colleagues within the care
homes team. *Invest to save £11/£ spent (based on 0.5 hours average per review, 8a pharmacist. Total cost for 445 reviews = £6543
Table 2: Outcome data for reviews 21/22 and 22/23.
Interventions/
review
(average)
Drugs
stopped/review
Annualised drug
cost
saving/review
No. of hospital
admissions
avoided/review
Hospital
admission costs
avoided/review
(£)
Total
annualised
drug cost
savings (£)
Total
hospital
admissions
avoided
savings (£)
21/22
(N = 286)
4.07 1.46 86.19 0.025 68.87 24,651 19,699
22/23
(N=445 )
4.52 1.30 86.15 0.026 82.19 38,341 36,578
Table 1 : Drugs included
in EMIS Search
Anticoagulants;
Hypnotics; Opioids;
Parkinson’s medication;
PPIs; Antibiotics for
UTIs; All drugs on aging
brain care ACB
scale*;Quinine;
Vitamin B compound
and strong
*Anticholinergic-
cognitive-burden-
scale.pdf
(corumpharmacy.com)