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, Polypharmacy reviews of asthma and COPD patients over 65 and 10 or more medicines, can be viewed here. For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

1. Chioma Nnamdi
Medicines Optimisation Team Lead, SYICB, Doncaster
POLYPHARMACY REVIEW OF PATIENTS AGED OVER 65 TAKING 10 OR MORE
MEDICINES
SUMMARY
POLYPHARMACY REVIEWS IN 10 PRACTICES IN DONCASTER NORTH PCN FOR PATIENTS WITH ASTHMA/COPD, AGED OVER 65
YEARS AND TAKING 10 OR MORE MEDICATIONS.
AIM
Doncaster is an ex-mining area with a consequent high prevalence of respiratory diseases. Data from Open prescribing showed a
spend of £8.2 million on items for respiratory system in Doncaster from Oct.22 -Sept 23. This project aimed to review patient inhaler
techniques to help improve compliance and outcomes and to deprescribe any inappropriate medications for improved safety.
https://openprescribing.net/analyse/#org=CCG&orgIds=02X&numIds=3&denom=nothing&selectedTab=summary
The selection criteria of patients with asthma/COPD, aged over 65 years and taking 10 or more medications was aimed at targeting
patients at the highest risk of hospitalisation.
PROJECT OVERVIEW
TASK SEARCHES - CREATED BY MEDICINES OPTIMISATION TEAM (MOT)
CLINIC BOOKING - ADMIN STAFF IN THE PRACTICES
PATIENT REVIEWS - DONE BY MOT (CHIOMA)
REFERRALS - NURSE PRACTITIONER (NP) OR GP
EXCLUSIONS - HOME BOUND PATIENTS (DUE TO LACK OF
CAPACITY IN THE MOT AND INDEMNITY
REQUIREMENTS).
A search was created on the clinical systems to identify the
appropriate patients. They were contacted by practice staff
and invited for a medication review accompanied by
family/carer (where appropriate) They were booked into
clinics and informed to bring all their medications including
their inhalers. The medication reviews were done by the MOT
and inhaler techniques checked
OUTCOMES
INHALER TECHNIQUE MEDICATION CHANGES REFERRALS
A total of 50 patients reviewed,
5 per practice. Patient consents
were sought and received prior
to the reviews
30/50 (60%) patients had poor inhaler
techniques. Some were confusing the
techniques for pMDI with DPIs. Others used
their ICS inhalers only when symptomatic
12 medications stopped
including laxatives, PPIs
where the NSAID course
has finished
4 patients
referred to NP
for overdue
COPD reviews
Some used SABA daily prior to use of ICS as
were instructed 20 years ago
SABA inhalers on monthly
repeats changed to prn
Over-use of SABA inhalers were high in general Patient education and
safety netting was done
CONCLUSIONS/RECOMMENDATIONS
Inhalation techniques were generally poor, this was flagged up at the PCN meeting and the respiratory group meetings. The nurses
agreed that some historical patients insist on using SABA inhalers to ‘open up’ the airways prior to using ICS inhalers, as that was the
practice years ago. This was shared with the respiratory team at DBTH, who agreed to escalate to their governance meetings.
The recommendation to the primary care nurses was (1) to ensure patient knowledge and inhaler technique checks were thorough
during annual reviews. (2) Harmonise inhaler device for patients using multiple devices (instead of using 1MDI + 1 DPI) so that the
techniques are the same or use a triple inhaler for appropriate patients to enhance compliance. (3) Review of all patients with more
than 6 SABA inhalers per year and reduce as appropriate.
The MOT is subsequently doing more work around respiratory conditions including setting up a Respiratory steering group,
organising more training for clinicians and support for developing asthma and COPD policies.