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, Reducing medication related falls risk in patients with severe frailty, can be viewed here. For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

1. Reducing Medication related Falls Risk in patients with Severe Frailty
Background
Patients with severe frailty are often at risk of side effects from medication.
These patients are often experiencing multimorbidity, resulting in
polypharmacy and are often managed to targets which may put patients at
risk of side effects which may result in falls and other complications.
The tight target controls for hypertension and diabetes have been relaxed in
the GP contract for patients with severe frailty to avoid over zealous
treatment, but where patients are meeting the lower targets these are
sometimes overlooked unless the patient or carers voice concerns about side
effects or the patient experiences an adverse event.
Results
43 patients were reviewed during the time period. Patients were aged
between 65 and 99, and prescribed between 6 and 16 medicines. An average
of 11 medicines per person.
16 patients (37%) had a medication stopped or the dose of a medication
reduced.
The most frequently stopped drug class were the antihypertensives, followed
by those with a high anticholinergic burden such as amitriptyline, and then
hypoglycaemic agents eg sulphonylureas.
Miscellaneous agents included tamsulosin, statins, and memantine.
Juliet Bell – Senior Pharmacist – Ribblesdale Medical practice
Aim
To reduce the risk of falls in patients with severe frailty by conducting a
structured medication review with patients and/ or their carers, providing an
opportunity to explore whether there are any risks of falls, and to agree
changes to medication regime through shared decision making.
Method
Using searches available through EMIS, patients with severe frailty were
identified. Patients were invited for review with the Practice or PCN
Pharmacist.
Details of the review were recorded and any medication changes documented.
Patients understanding and concerns about their medical conditions were
addressed as part of the review, including any changes to lifestyle which may
have been impacting on their health. The results were then collated
Conclusions
Multimorbidity and subsequent polypharmacy increases the risk of adverse
effects to medicines in patients with severe frailty.
Patients should be regularly reviewed, and investigated for symptoms of over
medication, despite appearing to be well controlled to previously determined
targets.
Antihypertensives
Hypoglycaemic agents
Dependence forming
medicines
Medicines with a high
anticholinergic burden
Anticoagulants
Miscellaneous