Complex Medication Review Robert Hallworth Chair – Greater Manchester Non-Medical Prescribing Network Oldham Primary Care Trust

The Levels of Medication Review Level 0 – Ad Hoc Level 1 – Prescription Review Level 2 – Concordance & Compliance Review Level 3 – Clinical Medication Review

Medication Review - particular risk groups identified in Older People NSF Those on 4 or more medicines Post-discharge from hospital In care homes Where medicine-related problems have been identified Patients over 75 Following an adverse change in health

Patient CB Paracetamol – under dose? Gaviscon – under dose? Prochlorperazine – under dose? Adverse effects? Propranolol – interaction with diltiazem? Pholcodine – under dose? Adverse effects?

Patient CB Clopidogrel – indication? Adverse effects? Dilitiazem – adverse effects? Monomax – dose timing Bezafibrate – use with a statin? Quinine bisulphate – indication? Metformin – what is the intended dose?

Patient CB Lansoprazole Fastabs – Dose. Cost effectiveness Furosemide – indication Nicorandil – is it needed? Adverse effects? Terbinafine – course length Ferrous sulphate – indication. Adverse effects.

Patient RK BP control Diabetes control Weight – orlistat? GI symptoms Nicorandil Lipid modification Smoking Asthma

Patient RK Angina Depression / mental health Pain Monitoring – BP, HbA1C, BG, U&Es, lipids, LFTs, PEFR

The NO TEARS tool Need and Indication Open questions Tests and Monitoring Evidence and Guidelines Adverse Events Risk Reduction or Prevention Simplification and Switches

Questions? Thank you