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
Medication question
Hello. Thank you for presenting your work on potentially inappropriate medications. One piece of information that I would like to know is, what was the average reduction of PIMs prescribed following the intervention? How would you plan to integrate such medication reviews in to standard practice?
Hi, thank you for your…
Hi, thank you for your questions.
The proportion of patients with potentially inappropriate medications (PIMs) was 40% in Cycle 1 and 70% in Cycle 2. This apparent increase likely reflects improved identification of PIMs through more consistent use of deprescribing tools, rather than an actual rise in inappropriate prescribing. Our intervention therefore enhanced detection and review, rather than immediately reducing the absolute number of PIMs in a small sample size. A longer-term, larger-scale project would be needed to demonstrate a measurable reduction in prescribing prevalence.
To embed this into standard practice, we propose:
Incorporating structured medication reviews (SMRs) into daily ward rounds for older patients with polypharmacy.
Using electronic prompts or checklists based on STOPP/START and Beers Criteria within prescribing systems.
Delivering regular staff teaching and reminders to sustain awareness.
Ensuring documentation and communication of medication changes is standardised in discharge summaries.
This approach would support deprescribing as a routine part of inpatient care and help reduce PIM burden sustainably over time.
Thank you for your poster,…
Thank you for your poster, please could you tell me a bit more about how you categorised potentially inappropriate medications and were any stopped during admission or were all adjusted as part of the discharge?
Hi, thank you for your…
Hi, thank you for your question.
We categorised potentially inappropriate medications (PIMs) using validated deprescribing tools — specifically the STOPP/START criteria. Each patient's regular medications was reviewed against these tools to identify medicines that were either unnecessary, potentially harmful, or lacking a clear current indication.
In terms of action, the PIMs were stopped during the inpatient stay, particularly where there were immediate safety concerns (e.g., high fall risk with sedatives, multiple antihypertensives etc). Changes were clearly documented and communicated to the GP via the electronic discharge document. This ensured continuity of care and allowed for further follow-up in primary care.