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, Review of ferrous sulphate prescribing, can be viewed here. For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

1. Review of ferrous sulphate prescribing
Background/Problem/Issue
• NICE guidance review in November 2021 https://cks.nice.org.uk/topics/anaemia-iron-deficiency/
• Prescribing leads unaware of key changes:
• All patients with iron deficiency anaemia should be prescribed one tablet daily of oral ferrous sulphate, ferrous
fumarate or ferrous gluconate
• Continue treatment for 3 months after iron deficiency is corrected to allow stores to be replenished
• If once daily dose is not tolerated, then reduce the dose to one tablet daily on alternate days or consider
alternative oral preparations
Results/Data
• 29 (39%) patients had their iron supplements stopped as treatment was no longer needed
• 41 (55%) continued, either long-term treatment or short-term (3m)
• 2 patients still awaiting bloods
• 2 patients had died during the review (unrelated deaths)
Of the 41 continuing treatment:
• 12 (29%) patients had their dose changed
• 18 (43%) patients required no changed as on correct dose
• 14 (34%) remained on their current increased dose as they are currently under care of oncology, renal,
palliative, gastroenterology or dieticians
• All patients were counselled if they required a change
Alison Hunter (with support from Dr. Miles)
Aim
• In line with new revised guidelines:
• To review patients on iron supplementation to ensure they are taking the correct dose for their condition
• To ensure patients benefit from their treatment and their anaemia improves
• To ensure that patients are not taking iron supplements unnecessarily due to lack of follow up monitoring
• To upskill prescribers ensuring they are aware of the latest clinical guidelines
Method/Strategy for Change
• Ran an EMIS search for all patients on iron supplements
• Reviewed all 74 patients (indication, dose, recent monitoring, current compliance)
• Requested bloods where needed – 16 patients
• Spoke to patients to confirm dose being taken where necessary
• Discussed patients with GP when needed
• Shared decision-making conversation with patients
• Amended doses as appropriate
• Confirmed details with patients
Conclusions/Lessons Learned
• Quality of prescribing was improved at the practice in line with current guidelines.
• 39% of patients no longer taking medication that wasn’t required
• Where appropriate doses were reduced in line with revised guidelines
• Reduced medication burden
• Reduced side effects
• Reduced cost of prescribing
• Some patients remained on the higher dose in the short term
• Clinicians were updated on the guidance to ensure that future prescribing is in line.
Next steps
• 14 patients remain on a higher dose.
• Advice currently being sought from secondary care as to whether their doses can be amended
• Revisit patients on laxatives to consider further deprescribing if no longer needed
• Project to be expanded across the other 6 practices in the PCN- work has already started on this
• Plan to roll out across ICB place as part on local incentive scheme