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

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

3. 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

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

6. 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?

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

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

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

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

11. Questions? Thank you Robert.Hallworth@nhs.net