Improving the appropriateness of polypharmacy reviews during hospital admissions: A three-stage retrospective quality improvement project

Introduction:

Inappropriate polypharmacy is the use of medications with no evidence-based indication, unmet treatment goals, high risk of adverse drug reactions, or when the patient is unwilling / unable to take treatment as intended. This is particularly concerning in geriatric care, due to increased risk of hospital admissions, adverse drug reactions and significant healthcare costs. To address these risks, clinicians should conduct patient-focused medication reviews. This project aimed to assess and improve polypharmacy reviews at Royal Albert Edward Infirmary (RAEI), with a focus on reducing inappropriate polypharmacy and it’s associated risks.

Method:

Data was collected retrospectively from September 2024, December 2024, and June 2025 (n=60), using ‘Hospital Information System’. Demographics included age, sex, Clinical Frailty Score and primary diagnosis. Admission and discharge medications were reviewed, alongside Anticholinergic Effect on Cognition (AEC) scores, documentation of medication changes, patient involvement and formal medication reviews. Interventions included weekly combined doctor-pharmacist ward rounds, electronic deprescribing alerts, and education sessions for doctors.
 

Results:

Documented deprescribing discussions increased from 0% baseline to 45% Dec 24 and then 60% Jun 24. The proportion of regular medications discontinued rose from 10% to 17% and then 20% over the three cycles. Despite these efforts, on average, patients were discharged with a higher number of medications before intervention, initially 8.7 vs 9.6, then 11.2 vs 11.3 post intervention and higher again - 9.3 vs 10.4 in cycle three. As a result, discharge AEC scores across cycles one, two and three generally reflected this, with a 15% increase, 4% decrease, and 4% increase, respectively. Commonly deprescribed medications included anti-hypertensives and statins; commonly initiated medications included laxatives and vitamin supplements. Analgesia was often adjusted.

Conclusions:

This project demonstrated that system interventions in frailty to promote polypharmacy reviews can reduce the number of inappropriate medications. While the overall number of discharge medications and anticholinergic burden did not consistently decrease, this is understandable given that hospital admissions often necessitate starting new treatments. Ultimately, patient centred medication reviews will optimise polypharmacy management, reduce harm and improve patient outcomes.