Helping Sussex take a new approach to polypharmacy

Principal pharmacist Helena Stimpson discusses how the Health Innovation Network’s polypharmacy programme influenced her team’s approach to structured medicine reviews (SMRs), and how she is sharing what she learnt in Sussex.

Working with frail patients

I work in a team that visits patients in their homes to complete medication optimisation reviews. Our patients are typically frail and complex and often impacted by polypharmacy – the use of five or more regular medications, which can in some cases cause problems.

In 2022, I was selected to be one of three Sussex polypharmacy trainers as part of  the Health Innovation Network’s Polypharmacy Programme. This aims to help health professionals identify patients at risk of harm due to multiple medications and encourage better conversations about medicine.

As part of a Polypharmacy Action Learning Set (ALS), I learnt tools and developed techniques to guide clinicians and patients through structured medicine reviews.

Improving our team’s approach to Structured Medicine Reviews

Following the action learning set, I was able to adapt my own team’s approach to structured medicine reviews to more confidently involve the patient in decision-making.

To prepare patients for SMRs, we now use resources like patient invitation letters, medicine trackers and guides to stopping medicine. Patients have told us that these help them ‘know what to expect’ from a medication review visit and to understand possible adverse effects from stopping their medicine.

To prepare our health professionals, we include the Health Innovation Network structured medication resources in our induction training. We also hold regular peer discussions on clinical cases and ensure our whole team is aware of available polypharmacy and deprescribing tools.

Our newest pharmacist in the team, Christian, is not yet a prescriber but was eligible for the ALS foundation course. He was keen to navigate the deprescribing guidance that he had learnt about during his induction and time working in our team. He wanted to learn more about the tools and approach to using this guidance with the frail elderly patients on our caseload.

Christian – “The ALS foundation course highlighted the use of Prescqipp and the Anticholinergic Burden (ACB) calculator, which I have since used successfully when deprescribing. Prior to this role, my background was in a hospital setting where the focus was not on deprescribing. The ALS foundation course is highly beneficial for those pharmacists and pharmacy technicians who, like me, have started seeing patients in the community.”

Upskilling the system

In January 2024, I co-presented a local polypharmacy session to primary care and community care pharmacists with the two other accredited Sussex trainers. The aim was to give them the knowledge and confidence to review and address polypharmacy in our local system.

We have also co-chaired the Health Innovation KSS local polypharmacy Community of Practice in Sussex, a forum in which peers can discuss common challenges and solutions. In these sessions, we have covered:

• Anticholinergic Burden
• Improving Medication Reviews in Older People at Risk of Falls Due to Medication Causing Low Blood Pressure
• Deprescribing Protein Pump Inhibitors
• Support and Resources to Prepare Patients for their Structured Medication Reviews

With the two other Sussex trainers and Health Innovation KSS, I have contributed to a working group to support Sussex ICB in understanding some of the challenges and barriers to the provision of high-quality SMRs. This will help inform a wider plan that aims to improve outcomes for the frail population living in the emerging Integrated Neighbourhood Teams

Increasing patient satisfaction and optimising savings

Our team’s medication optimisation reviews have previously been able to demonstrate a reduction in possible harm and hospital admissions as well as cost savings associated with deprescribing.

I anticipate that by using the Health Innovation Network tools and training to help identify patients most at risk and needing review, appropriately deprescribing medication and involving patients in the process that we will be able to demonstrate further harm reduction and savings in the future.

Find out more about our polypharmacy programme.