Tools to aid and identify patients for polypharmacy review Dr - - PowerPoint PPT Presentation

Tools to aid and identify patients for polypharmacy review

Dr Pamela Mills Principal Pharmacist Redesign Jane Hall Principal Pharmacist Pharmacotherapy Rachel Falconer General Practice Clinical Pharmacist

Background

• Polypharmacy guidance recommends criteria

✓>50 yrs in care home ✓Prescribed >10 medicines ✓High risk medicine ✓Approaching end-of-life

• Non-specific - patient numbers exceed capacity

Patient Prioritisation

• Tools developed to aid patient prioritisation

➢Prescribed medicines

[Enhanced Medication Summary (EMS)]

➢Patient acuity

[Ayrshire Polypharmacy Attendance Cognition Evaluation (APACE)]

Enhanced Medication Summary (EMS) tool

Jane Hall

What is EMS?

• A list of patients suitable for polypharmacy review -

information from practice clinical system

• Patients that meet the criteria outlined in the

Scottish Polypharmacy guidance

– > 65yrs on 10 or more meds or > 50yrs in a care home

• A printable document for each patient to aid review
• Reduces time spent on manual work up

Prescribing Indicators

• IT system automatically checks if the patient

triggers > or = 1 of ~120 prescribing indicators:

– High risk prescribing – Potential over treatment – Monitoring required – Potential under-treatment

• Patients ranked in order with patients triggering

highest number of indicators at the top

EMS REPORT FOR MRS EB

Recent addition – falls review

Patient Identifiers:

➢ 10+ active repeat medicines ➢Cognitive impairment ➢Multi-morbidities ➢Frailty score ➢No. of GP consultations ➢No. of A+E attendances ➢Previous PPR, ACP, KIS, care home Score calculated to rank patients in order of priority

APACE Tool

Patient Case

77 yr old female Dx: COPD, back pain, hypertension, osteoporosis, gastric ulcer, iron deficiency anaemia, memory loss 14 repeat medicines Blister pack Home visit, husband also present Main concerns: Worsening SOB, pain management, TATT

Repeat Medicines:

➢Adcal D3 caplets – two bd (indication?) ➢Erythromycin 250mg tabs – rescue meds (over-ordering, remove from repeats) ➢Ferrous fumarate 210mg – one bd (check FBC/haematinics) ➢Ipratropium 500mcg/2ml nebules – not ordered since 06/17 (remove) ➢Omeprazole 20mg caps – two daily (reduce to 20mg daily) ➢Paracetamol 500mg/Dihydrocodeine 30mg tabs – two qds (only 42kg -reduce to 1 qds) ➢Perindopril 4mg tabs – one daily (non-formulary, check BP) ➢Prednisolone 5mg tabs – rescue meds (remove from repeats) ➢Pregabalin 50mg caps – one at night (review ongoing need, trial stop?) ➢Relvar Ellipta 92/22 – one puff daily (step up - add Incruse?) ➢Salbutamol inhaler – 2 puffs prn (review use/issue spacer) ➢Salbutamol 2.5mg nebules – one qds ➢Sertraline 50mg tabs – one daily (review mood) ➢Tramadol 50mg caps – one tds (effective? s/e? Reduce/stop? try topical NSAID?)

Polypharmacy Review

Key Findings from using APACE

➢Patients identified and prioritised for review that may not have previously been flagged i.e. No ‘high risk indicators’ triggered but poor compliance/understanding due to cognitive impairment ➢Opportunity to address any pharmaceutical care issues

• ffer compliance aids as well as signpost to other

services and healthcare professionals if required ➢Use in conjunction with EMS tool (where available)

Key Findings

➢Complex cases Many patients have mental health and social issues so require additional input, multiple visits and shared care to achieve treatment goals

➢Opportunity for patient education & facilitate family/carer engagement

Positive feedback so far when conducting visits

Conclusion

• Tools achieve aim for patient prioritisation
• Combination of medicine and patient factors
• Polypharmacy reviews enhanced