1. Polypharmacy Pharmacist Consultant Liz Butterfield FRPharmS
KSS ASHN Expo
19th January 2016 1

2. Polypharmacy

3. Background to polypharmacy in older people
Particular concern in older population as medicines are not broken down in the body as effectively as when younger
Multi-morbidity common and multiple medicines also common.
Older person in a care home is prescribed an average 9 medicines
Complications can lead to new illness, accidents such as falls, cognitive decline and increased risk of admission to hospital
Polyprescribing – can result from prescribing cascade
Kings Fund report 2013 – Polypharmacy and Medicines Optimisation – Making it Safe and Sound – Appropriate Polypharmacy and Problematic Polypharmacy
End of Life care – continuation of preventative medicines?

4. Anticholinergic drugs cause cognitive impairment
Anticholinergics Procyclidine Orphenadrine Trihexyphenidyl(Benzhexol) Atropine
Antipsychotics Olanzapine Risperidone Quetiapine Haloperidol Aripiprazole
Antihistamines Promethazine Hydroxyzine Chlorphenamine Cinnarizine
Tricyclic Antidepressants Amitriptyline Dosulepin Clomipramine Nortriptyline
Urinary Incontinence Oxybutynin Tolterodine Solifenacin Propantheline
Sedating drugs can cause cognitive impairment
Benzodiazepines Diazepam Lorazepam Oxazepam Temazepam Clonazepam
Opioid Analgesics Codeine Fentanyl Morphine Oxycodone Tramadol
Antidepressants Mirtazapine Trazodone
Hypnotics Zopiclone Zolpidem
Anticonvulsants Carbamazepine Valproate Levetiracetam Pregabalin Gabapentin

5. Key Challenges for Medicines Optimisation
Ensuring that Appropriate Polypharmacy is still appropriate
Strategies to minimise Problematic Polypharmacy
Approaches to prescribing in the elderly to prevent polypharmacy – prescribing cascade
Skills and training around deprescribing
Multi-morbidity – should we follow national guidelines for combination of conditions – particularly preventative therapies
Patient-centered approach with shared decision making
Regular Medication Review?

6. Overview of AHSN Polypharmacy Project plans
Aim to generate cash releasing savings
Plan to work with care homes to undertake/increase number and pace of medicine reviews
Plan to work with 4 localities across Kent Surrey Sussex who have already made some progress with polypharmacy
Support will depend on needs of locality to progress their work – might be funding, project management support, clinical support etc.
Project to focus on solid action, metrics and impact
Plan to broaden reach in year 2

7. Some examples of good practice in KSS
Care Home Medication reviews scheme, Brighton and Hove moving into its 5th year from April
Guildford and Waverley, polypharmacy reviews in older people
Medway – Polypharmacy in the elderly
Coastal West Sussex – Proactive Care Multi-disciplinary teams