Guidance and Additional Resources
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Polypharmacy has been described as the use of multiple medications by a patient generally, but not exclusively, older adults aged 65 and over. Polypharmacy is a key issue in health and social care, as evidence suggests that being on multiple medications increases the individuals’ risk of harm and contributes to hospital admissions and poor therapeutic outcomes. Indeed, patients on 10 or more medicines are over 300% more likely to be admitted to hospital.
As part of the efforts to address polypharmacy, Wessex Academic Health Science Network (AHSN) led a small working group consisting of members of North East and North Cumbria AHSN, NHS BSA, NHS Digital, local GPs, Pharmacists, prescribing analysts and clinical specialists in the development of prescribing comparators (see Appendix 1). An initial suite of nationally available prescribing comparators at CCG and GP Practice level was developed to highlight the variation in prescribing activity with respect to polypharmacy.
The polypharmacy prescribing comparators were then reviewed at a workshop that was open to all AHSNs in England and the Royal Pharmaceutical Society. Modifications were made in light of comments and suggestions made during this all-day workshop.
A set of prescribing indicators have been developed as part of a programme of work to reduce medication error and promote safer use of medicines, including prescribing, dispensing, administration and monitoring. The programme of work is in response to the World Health Organisation (WHO) global challenge – Medication without Harm. More information can be found in the report of the Short Life Working Group.
The analysis is an experimental piece of work. This is the first-time prescribing data has been linked to admissions data at a national level.
The purpose of the indicators is to identify hospital admissions that may be associated with prescribing that potentially increases the risk of harm, and to quantify patients at potentially increased risk. The aim of the indicators is to:
• support local reviews of prescribing, alongside other risk factors for potential harm
• minimise the use of medicines that are unnecessary and where harm may outweigh benefits
• identify where the risk of harm can be reduced or mitigated including prescribing of alternative medicines or medicines that mitigate risk e.g. gastro-protective agents
• reduce the number of hospital admissions that may be associated with medicines
• reduce the number of patients that are potentially at increased risk of hospital admission that may be associated with medicines.
Where an admission has been recorded that is linked to a patient currently taking medicines that may increase the risk of harm it is still possible that the cause of admission (e.g. GI Bleed, AKI) may be due to other external factors. The analysis only highlights the potential risk of harm and possible association with hospital admission. Any review of benefits and risks of prescribing should be undertaken on an individual patient basis.
Respiratory prescribing is highly complex, with a huge variety of inhalers and medicines available. There are several illnesses affecting the respiratory system, but the main two areas of interest for this dashboard are asthma and chronic obstructive pulmonary disease (COPD). Patients with other illnesses will be included in the results of the comparators, but the group has not considered the evidence for illnesses other than asthma and COPD.
Every month, the NHS in England publishes anonymised data about the drugs prescribed by GPs. But the raw data files are large and unwieldy, with more than 700 million rows. Please follow this link to explore The Open Prescribing website that is making it easier for GPs, managers and everyone - supporting safer, more efficient prescribing.
The medicines optimisation programme aims to help patients get the maximum benefit from their medicines and reduce waste. Each area of work in this programme intends to make medicines optimisation part of routine practice, ensure medicines use is as safe as possible and understand the patients’ experience.
We are focusing on a number of key areas to improve support for patients to get the best from their medicines:
- transfers of care between hospital and local pharmacists
- management of appropriate polypharmacy
- medicines safety
Frequently Asked Questions
The medicines optimisation dashboard makes it easier for our users to develop plans to ensure that all patients achieve the best possible outcomes from their treatment, wherever they live.
The dashboard features:
- Easy to use interface based on NHS RightCare’s Instant Atlas
- Time series analysis to enable trends to be monitored
- More regular refresh of data
- New patient experience metrics
- Ability to extract visuals for use in presentations
Medicine safety: indicators for safer prescribing
A series of indicators to inform safer prescribing practice to help pharmacists, clinicians and patients review prescribed medication and prevent harm can be accessed via this link.
More information on the medication safety indicators used in this dashboard can be found by following this link