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Polypharmacy and deprescribing
Polypharmacy refers to prescribing or use of more than a certain number of medicines, such as ten or more.
In recent years polypharmacy has been refined to:
Prescribing for a person:
- for complex conditions or for multiple conditions
- in circumstances where medicines use has been optimised
- where the medicines are prescribed according to best evidence
Prescribing multiple medicines inappropriately. Or where the intended benefits of the medicines are not realised.
Deprescribing is the process of safe and effective cessation (stopping) of inappropriate medication. It recognises that much of the evidence to support stopping medicines is empirical. It is based on the patient’s physical functioning, co-morbidities, preferences and lifestyle.
It is not about denying medication. It’s about reducing harm and the use of unnecessary medicines. Some medicines have a high risk of adverse effects. These include falls, gastrointestinal bleeding, or acute kidney injury. Or the medicines could have limited benefit to that person.
Deprescribing is particularly important when a person is frail.
A variety of resources and screening tools can help. They guide decision-making about the appropriateness of prescribing and stopping medicines (deprescribing).
Clinicians need to adopt a person-centred approach when implementing strategies. These strategies must address problematic polypharmacy. They must take into consideration the person’s preferences, beliefs and lifestyle.
People need to be supported to make an informed decision.
Some people do not have capacity to make decisions about their treatment. Their relatives should be involved in the decision-making process.
There should be clear documentation of the changes made, the reasons and any monitoring required.
There needs to be effective communication with all relevant parties. This could be the community pharmacy. For people living in care homes, it could be the staff responsible for ordering medication.
Example of a person-centred approach
Mrs Baker is prescribed a medicine to manage her symptoms of urinary incontinence. The medicine is associated with side effects. These include dry mouth/eyes, sedation, confusion and decreased cognitive function. The team is reviewing her medicines. They discuss the side effects with her. They ask if she would consider a trial withdrawal. This could establish if she is still benefiting from the medicine.
Mrs Baker wants to continue taking something for her incontinence. It gives her time to get to the toilet and to avoid accidents.
The team and Mrs Baker agree to reduce the dose of the medicine gradually to see if a lower dose can maintain her.
Mapping to the CQC key lines of enquires
- S4.5 - How does the service make sure that people’s behaviour is not controlled by excessive or inappropriate use of medicines?
- S4.7 - How does the service engage with healthcare professionals in relation to reviews of medicines at appropriate intervals?
- Last updated:
- 02 December 2019