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, Evaluating the impact of a specialist frailty multidisciplinary team pathway with clinical pharmacist involvement, can be viewed here. For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

1. Evaluating the impact of a specialist frailty multidisciplinary
team pathway with clinical pharmacist involvement
Alex Spurling
Background
Frailty is one of the leading risks to global public health and
a leading cause of death for older people.
When tackling the complex care needs of the frail
population, medication use is a key consideration.
Evidence shows that prescribing for older people is generally
suboptimal and inappropriate polypharmacy is often
experienced.
Method
Nottingham University Hospitals (NUH) launched a
specialist frailty multidisciplinary team (MDT) and pathway
which included a specialist pharmacist.
Aim or MDT: Optimizing medicines and reducing
readmissions to hospital.
Suitable for: Patients assessed as frail on admission
(Rockwood frailty score of 6 or more) and likely to be
discharged within 72 hours.
Study: Retrospective cohort study comparing this MDT
pathway (350 patients) to standard care (350 patients).
Data collected using a forward sequential sampling
approach based on discharge date and for each patient
included:
• Personal characteristics
• Length of stay (LOS) and admission/readmission were
recorded,
• Medication, dose/ frequency/ route and quantity on
both admission and discharge.
• Where medications were changed, the quality of
information on the discharge summary was also
assessed.
Strengths & weaknesses
Strengths: longitudinal cohort design allowed for:
• Individuals to be followed up over time.
• Consideration of multiple factors including LOS and
readmission data.
• Identification of whether the medication changes were
continued to be adhered to in Primary Care.
Limitations: As with other retrospective studies there was a
reliance on the accuracy of medical records rather than data
being collected specifically for the study.
Conclusion
This evaluation has highlighted the benefits of the specialist
frailty MDT pathway model at NUH that includes a specialist
pharmacist.
The pathway has successfully reduced the percentage of
new medicines prescribed during hospital stays, increased
permanent deprescribing in the Primary Care setting.
It is likely that the results and model of care described in
this study is translatable across different care settings
Results & Conclusions
The findings of this study provide insight into the impact of
the specialist frailty pathway at NUH.
The medications prescribed i.e. type/numbers were similar
on both pathways but there were considerable differences
shown in the types of changes made:
In summary in the specialist MDT:
• 7% fewer medication changes overall
• 33% permanent stops compared to 27% in standard
care
• Half as many temporary stops
• Was less likely to initiate new medications
• Changes were more likely to persist in GP practice which
was thought to be due to the better quality of
information on discharge:
54.2
14.6
25.6
4.6
1.1
66.6
12.1 14.9
5.3
1.1
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Persistent Not Persistent Lost to follow up Review Not Sure
Proportion
of
decisions
persistent
at
3
months
post
discharge
(%)
status of persistence to decision
STANDARD CARE SPECIALIST FRAILTY
For further information please see :
https://emashn.org.uk/images/EM
AHSN_Specialist_Frailty_MDT_Path
way_Service_Evaluation_Final_Rep
ort.pdf