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, Mind over bladder - Prevent harm associated with excessive or inappropriate anticholinergic burden, can be viewed here. For more information about the polypharmacy programme, please visit https://www.ahsnnetwork.com/programmes/medicines/polypharmacy/

1. Reducing Polypharmacy and ACB Scores: A Multi-Faceted Approach
for Improved Patient Outcomes
Maria Gilbert
• References:
1. Salahudeen, M. S., Duffull, S. B., & Nishtala, P. S. (2015). Anticholinergic
burden quantified by anticholinergic risk scales and adverse outcomes in
older people: a systematic review. BMC geriatrics, 15, 31.
2. Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What
is polypharmacy? A systematic review of definitions. BMC geriatrics,
17(1), 230.
3. Dhalwani, N. N., Fahami, R., Sathanapally, H., Seidu, S., Davies, M. J., &
Khunti, K. (2017). Association between polypharmacy and falls in older
adults: a longitudinal study from England. BMJ Open, 7(10), e016358
What Went Well:
1.Data-Driven Approach: The utilisation of SystmOne to identify
high-risk patients was effective.
2.Proactive Communication: The process of reaching out to patients
via SMS or letter for scheduling SMRs seems to have worked well,
leading to successful completion of numerous SMRs.
3.Educational Initiatives: Increasing clinician awareness about the
risks of ACB medications likely contributed to safer prescribing
practices.
4.Positive Initial Results: 15 patients saw their ACB scores decrease
significantly. The absence of new high-risk patients in the recent
monthly searches.
What Could Have Gone Better:
1.Patient Reachability: Some patients did not have mobile numbers,
indicating a possible gap in communication channels.
2.Ongoing Monitoring: Maintaining momentum is critical. It would
be beneficial to develop strategies for ongoing patient engagement
and continuous clinician education to ensure sustained
improvements.
Results:
1.Our initial search identified 50 patients Of these,
25 had not had an SMR in the preceding 12
months.
2.Contact was established with all 25 patients.
3.24 SMRs were conducted.
4.15 patients saw their ACB scores decrease from
>5 to below 3.
5.Clinician awareness regarding ACB risks
improved, evidenced by no new high-risk patients
identified in the monthly searches over the last two
months.
Conclusions:
We demonstrated that a systematic, multi-faceted
approach to managing polypharmacy and high
ACB scores can yield significant improvements in
both patient safety and clinician awareness.
Regular monitoring, proactive patient
communication, and clinician education have
proven to be effective strategies.
This process ensured a proactive and comprehensive
approach towards tackling polypharmacy and high ACB
scores in our patient population. As we moved through the
steps, we kept patient health outcomes and clinician
awareness at the forefront of our efforts.
Background & Actions
Tackling Polypharmacy & High ACB Scores:
In the face of escalating polypharmacy and high
Anticholinergic Cognitive Burden (ACB) scores
among patients1,2,3, we launched a quality
improvement initiative designed to mitigate
these risks.
Through these targeted strategies, we are
making strides in addressing polypharmacy and
high ACB scores, aiming for safer patient
outcomes and more informed prescribing
practices.
0 10 20 30 40 50 60
Initial Patients
Without SMR in last 12/12
Contact Established
SMRs Conducted
ACB Score Decreased
Number of Patients