Improving patient safety through ‘deprescribing’ unsafe medicines

Problematic polypharmacy is a global patient safety problem and tackling this has been highlighted by the Department of Health and NHS England through the National Overprescribing Review as a national priority. Structured medication reviews have been commissioned by NHS England and are a key activity for primary care pharmacists through the Primary Care Network Directed Enhanced Service. Medication reviews can be used to identify inappropriate medicines which can then be stopped (‘deprescribing’) to reduce the risk of harm. This is particularly important for patients who are at high-risk from medication-related adverse events, for example, older people, people living with frailty, people prescribed high-risk medicines (e.g. opioids, benzodiazepines, gabapentinoids), and people prescribed high numbers of medicines (e.g. >10 medicines ‘hyperpolypharmacy’).

However, to ensure medication reviews are conducted effectively and safely, they need to be patient-centred and supported by appropriate resources. We therefore conducted qualitative research to explore this further followed by experience-based co-design, to develop an ideal medication review process with supporting resources. This work was undertaken with older people living with frailty who were prescribed polypharmacy, along with primary care professionals. We designed a medication review invite letter to prepare patients to be able to more effectively contribute to medication reviews. We also designed a patient-held document explaining how to safely stop their medicines, and what actions to take if they experienced any problems.

We then worked with the Academic Health Science Network (now the Health Innovation Network) National Polypharmacy Programme to further develop these resources for national dissemination and implementation. The resources have been endorsed by NHSE and Age UK and translated into 11 languages along with audioversions in each of these languages.  They have been embedded into primary care systems and downloaded over 9000 times across England. The resources were positively evaluated in 27 areas nationally for people in seldom-heard communities: they improved access and the quality of medication reviews, leading to improvements in patient safety.

Link to resources: https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/patient-information/