Pinnacle Education Pod – July 2020: Pause and Monitor

The clinical advice resource is a growing suite of blog posts, advice sheets and resources aimed at helping Pinnacle practices provide high quality clinical care.

Polypharmacy: Thinking about the hundreds of thousands of patients on five or more medications a day, and the impact this may have on them in risk of falls, cognitive impairment, confidence and sheer work involved in managing the medications - what things could make a difference?

Here are four key activities for practices to consider.

Communicate with the whole team - including the community pharmacist

When making a change in medication it really helps the patient if the pharmacist knows why the change was made - they can reinforce the message, and make sure they set up the medication in the right formulation, or the right "pod" in the patient's daily dispensing tool.

The prescriber can write a "comment" to the pharmacist, which appears as a message when the prescription is viewed in the pharmacy - but it may be worth having a chat with your community pharmacist about how this actually looks.

In the olden days we could write a note on the prescription itself - is this method as effective and if not what can you both do about it?

Think about prompts for review of patient medication lists

When it is left to just remembering to do the right thing, people do the right thing maybe ten per cent of the time (depending on what the right thing is!), a visual reminder to think - maybe a poster on the wall - or a prompt or automated system that flags an alert when patients are taking more than five medicines, may be helpful.

Encourage proactive care and continuity of prescriber where possible

Patients who only come in when they are unwell, or with a long list of issues they have saved up, patients who don't care who they see are hard to deprescribe. Identifying patients who could benefit from a "proactive health care plan" may be a start, encouraging those patients to see the same prescriber each time, even if it does mean making an advanced appointment, using telehealth where you can to improve access, may all help.

Use the community pharmacy and medicines review teams

Actively referring people for a medicines review may be a bit of a faff, but even if it is just a personal connection you have with the community pharmacist and simply asking them for their help with a patient, making sure the patient really understands what the medicines are for, it can be really helpful.

For more information