The AHSN 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, Polypharmacy - focus ACB - Care homes, can be viewed here. For more information about the polypharmacy programme, please visit https://www.ahsnnetwork.com/programmes/medicines/polypharmacy/

1. Polypharmacy – focus ACB – Care Homes
Background
• Applying learning from Polypharmacy ALS 3 part training (9/11, 23/11, 7/12)
• Demonstrate learning and application through Quality Improvement Project
• Utilise NHS BSA Medicines Optimisation Polypharmacy Prescribing Comparators ePACT2….
• Hastings PCN – High Glades MC – Polypharmacy Prescribing parameters
Percentage of patients with anticholinergic burden score > 6 = 0.25% at 85 yrs+
• Work within current service contract – i.e. Care Homes
Results/Data
Kayt Blythin – Principal Clinical Pharmacist
kayt.blythin@nhs.net
Aim
• Access and apply variety of tools to deliver smart SMR
• To reduce prescribing of ACB using BRAN (benefits, risks, alternatives, nothing) approach
• Legacy impact of focus on polypharmacy across PCN
Method
• Care home residents with high ACB – Tools
• To compare search tools to identify patient cohort
• Conduct SMR utilising shared –decision making tools Nursing Home >65yrs on 2+ ACB meds: n= 7
• Reflect on process and identify next steps
Conclusions and Next Steps
What did you learn:
Most ACB prescribing is via mental health services in care home population
ACB scoring tools differ
Next of kin are very willing to participate in SMR “My mum is a different person since reducing her
medicines”
What worked:
Using Ardens search
Knowing the care home
Doing reviews annually and chipping away at polypharmacy
What didn’t work:
BSA ePACT2 data - >75yrs not wide enough age range; Oct out of date;
N=92 search via NHS number, then refine to care home residents
What would you differently
Involve the mental health team
What did you achieve:
Confidence in identifying ACB and appreciating cumulative effect
How do you plan to maintain improvement:
Share with PCN and wider MDT to consider ACB especially sleep aids – generate Legacy effect
Continue to spread links with other prescribing services
Calculate ACB for care home SMR
ASSESSING MEDICATION FOR DIZZINESS, DROWSINESS AND ANTICHOLINERGIC BURDEN (USING THE ANTICHOLINERGIC EFFECT ON
COGNITION TOOL
a practical tool for optimising prescribing for older patients4. Association between the use of Anticholinergics and the
risk of developing cognitive impairment and of death
a guide as to which areas anticholinergic burden is likely to be the highest:
AVOID : CAUTION: Alternatives
1. Percentage of patients with an anticholinergic burden score of 6 or more Aged 75 yrs and over n= 7(2 RIP, none CH)
2. Percentage of patients with an anticholinergic burden score of 6 or more n=92
Month(s) requested: November 2022
OLD Ardens> Network Contract DES: Parent Population: >65y and on 2 or more anticholinergic
medications (on repeat) n= 133, CH n= 43
• All patients lacked capacity
• 5 have Next of Kin advocate
• 5 are under care of mental health team
• 5 were mobile
• 5 had 2-6 falls in previous 12 months
• 6 had mirtazapine
• 4 made shared-decision SMR to reduce
ACB
• Targeting medicines that are symptom
control, rather than treatment, were
more acceptable to stop e.g. sleep aids
• SMR takes 60 mins
0
2
4
6
8
10
12
M 85y M 69 y F 75y F 72y F 82y F 89y M 67y
SMR ACB
Nos ACB meds @ START Medichec SCORE ACB calc SCORE Nos ACB meds @ END