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, Improving care in County Durham under the STOMP agenda - A 5 year review, can be viewed here. For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

1. IMPROVING CARE IN COUNTY DURHAM UNDER
THE STOMP AGENDA – A 5 YEAR REVIEW
NENC ICB MEDICINES OPTIMISATION TEAM (COUNTY DURHAM)
CONTEXT
• Stopping the over medication of people with a learning disability, autism or both (STOMP) is a national project to improve
management of behaviours that challenge and reduce the use of off-label psychotropic medication that could lead to
adverse effects and patient harm(1)
• Psychotropic medicines include antipsychotics, antidepressants, anxiolytics, hypnotics, and mood stabilisers. They are often
used in people with learning disabilities and autism to manage behaviour that challenges. Their use is often unlicensed(2)
• In 2017 prescribing levels in County Durham of psychotropic medications in patients with a learning disability or autism
were higher than national levels
• A county-wide patient audit identified that while almost half of patients were managed solely in primary care, clinicians
lacked confidence to conduct these medication reviews and make changes without specialist input.
References:
1. STOMP Call to action and research. NHS England NHS England » Call to action and research https://www.england.nhs.uk/learning-disabilities/improving-health/stomp/research/
2. Murray, M. L. et al. Pharmacological treatments prescribed to people with autism spectrum disorder (ASD) in primary health care. Psychopharmacology (Berl). 231, 1011–21 (2014).
INTERVENTION
• The County Durham Medicines Optimisation (MO) team, in
partnership with Tees Esk and Wear Valley (TEWV) mental health
trust, implemented an initial project to ensure STOMP reviews
were being completed for patients with learning disabilities and
autism.
• The project involved a team of specialist nurses completing
targeted reviews across the 22 highest prescribing practices
between April 2019 and March 2020.
• Following the review each patient had a tailored plan attached
to their clinical record, which then acted as a basis for any
medicines management activity
• The initial project received excellent patient and prescriber
feedback and was approved for continuation
• The MO team provided additional support during the initial
project including clinician education and national STOMP
resources
• The audit was redone in 2022 to determine if there had been
any changes from this intervention
0
10
20
30
40
50
60
70
% patients
prescribed a
psychotropic med
% meds for
management of
behaviour
% patients
managed solely in
primary care
% patients (on
meds) who had a
review in previous
12 months
% medications with
evidence of
reduction trial
2017 compared to 2022 for original pilot practices in County
Durham (results in %)
2017 results 2022 results
EFFECT OF INTERVENTION
• 8,485 patients were identified on internal learning
disabilities and autism registers across County Durham. A
61% increase on the 2017 registers.
• 881 (10.4%) patients were prescribed a psychotropic
medication for management of behaviour, a reduction from
2017 (14.4%) as per Figure 1.
• In the initial pilot practices the percentage of patients who
received a medication review within the last 12 months
rose from 26.3% in 2017 to 65.9% in 2022 as per Figure 1.
• There was a small increase in the number of medications
with an evidenced trial of reduction (18.9% in 2017
compared to 20% in 2022) as per Figure 1. However, there
was a relative decrease across all practices in County
Durham as per Table 2.
• General feedback from clinicians was that while they felt
more confident around the STOMP agenda, they still lacked
confidence to make changes to this medication.
CONCLUSIONS
• Targeted STOMP reviews in combination with MO education support sessions to GP practices and patient audits in County
Durham have been effective in raising awareness of STOMP in County Durham.
• So far a significant number of patients have had their medication reviewed and appropriately stopped or reduced and there
has been a reduction in prescribing volume across the County as per Table 2.
• In order to increase confidence of primary care prescribers to reduce medications it is planned that the next iteration of
this service will include more tailored advice, working with more of a one to one relationship with practices, and providing
ongoing medication review support from a prescribing pharmacist.
Figure 1 - 2017 compared to 2022 for original pilot practices in County Durham (results in %)
Criteria 2017 results 2022 results
Patients prescribed a psychotropic med
950 (40.1%) 1,610 (35.1%)
Patients who have had a review of this medication within
last 12 months
98 (26.3%) 386 (65.9%)
Number of these medications with documented trial of
reduction
107 (18.9%) 173 (20%)
Table 1 – Results for 22 pilot practices
Criteria 2017 results 2022 results
Patients prescribed a psychotropic medication for
management of behaviour
759 (14.4%) 881 (10.4%)
Patients who have had a review of this medication within last
12 months
591
608 (69%)
(77.8%)
Number of these medications with documented trial of
reduction
239
260 (20.4%)
(21.1%)
Table 2 – Results for all practices in County Durham