Abstract
Introduction:
Polypharmacy—commonly defined as the use of five or more medications—is highly prevalent among older adults and is associated with increased risks of adverse drug events, falls, cognitive impairment, hospital admissions, and reduced quality of life. Inappropriate polypharmacy, where medications provide limited benefit or cause harm, represents a significant patient safety concern. Structured medication reviews (SMRs), supported by validated deprescribing tools such as STOPP/START and Beers Criteria, are essential for identifying and addressing potentially inappropriate prescribing. This quality improvement project (QIP) aimed to assess and improve SMR practices in hospitalised older adults with polypharmacy.
Method:
A two-cycle prospective QIP was conducted on a Health Care of the Older Person (HCOP) ward at Lincoln County Hospital. Patients aged ≥65 years and prescribed ≥5 regular medications were included. Data was collected during two two-week periods from the same ward (Cycle 1: February 2025; Cycle 2: May–June 2025), with 20 patients reviewed in each cycle. Outcome measures included the prevalence of potentially inappropriate medications (PIMs), SMR completion, documentation in medical notes, and communication of medication changes to general practitioners via electronic discharge documents (EDDs). Interventions introduced between cycles included staff education sessions, e-mail reminders and visual reminders on the ward via posters.
Results:
In Cycle 1, 40% of patients were prescribed PIMs. SMRs were conducted for 80%, with documentation also completed in 80%. In Cycle 2, 70% of patients were on PIMs; however, SMRs and documentation were both completed for 100%. Medication changes were communicated to GPs via EDDs for 100% of patients in both cycles. These results demonstrate improved consistency and quality in medication review processes.
Conclusion(s):
Targeted, low-resource interventions significantly enhanced structured medication review practices. Embedding SMRs into routine inpatient care improves prescribing safety and optimises outcomes for older adults.
Comments
Great topic for a QIP! I…
Great topic for a QIP! I think managing polypharmacy is a very big ongoing issue for our Geriatric population. Can I ask, how much involvement did your ward pharmacist (if you have one on the HCOP ward) have in this project?
Hi, thank you for your…
Hi, thank you for your question.
in this project, our ward pharmacist was not directly involved, as the focus was specifically on structured medication reviews (SMRs) conducted by doctors. We wanted to assess how consistently doctors were identifying and addressing potentially inappropriate medications (PIMs) using tools like STOPP/START and the Beers Criteria, without pharmacist input.
This allowed us to evaluate doctors’ independent prescribing and deprescribing practices, identify gaps in confidence or knowledge, and target interventions such as teaching sessions and visual prompts accordingly. In future cycles, we would aim to involve pharmacists to further strengthen the multidisciplinary approach and improve sustainability.
follow up on patients?
Hi, thank you for an interesting poster. I was wondering if you did any follow up on the patients to ensure the changes were actioned by the GP/primary care? This is often a problem I have found in my practice with transfer of care, it can be especially problematic with patients with Dosette trays!