Is Education Enough? Sustaining Anticholinergic Burden Assessment Following Clinical Staff Rotation

Is Education Enough? Sustaining Anticholinergic Burden Assessment Following Clinical Staff Rotation 

Polypharmacy is common among older adults and increases their risk of exposure to medications with anticholinergic properties. High cumulative anticholinergic burden is associated with adverse outcomes, including cognitive impairment and falls. Routine assessment provides an opportunity to optimise medication use and reduce medication-related harm, but sustaining such practice can be challenging. This project aimed to assess whether improvements in anticholinergic burden assessment and documentation were sustained following clinical staff rotation. 

Data were collected prospectively across three cycles, each comprising four consecutive days of data collection in the Older Persons Assessment Unit. Patients aged ≥65 years who received a geriatric review were included. Key measures were documentation of anticholinergic burden scores and medication management plans. Following Cycle 1, baseline findings were presented, with 3 weeks of opportunistic staff education and educational posters displayed on the ward. Cycle 3 occurred 3 weeks after junior doctor and registrar rotation, with no further education, although posters remained displayed.

Documentation of anticholinergic burden increased from 0% (0/47) in Cycle 1 to 45.5% (15/33) in Cycle 2 following the intervention. Following rotation of junior doctors and registrars, documentation fell to 0% (0/30) in Cycle 3 despite educational posters remaining displayed. No medication management plans were documented in any cycle.

The intervention improved documentation of anticholinergic burden, demonstrating the value of education in supporting clinical practice. However, this improvement was not sustained following staff rotation, despite educational posters remaining available. The absence of documented medication management plans suggests that identification alone may not translate into action.  Sustaining practice may therefore require active reinforcement, system-level prompts and a clear escalation pathway to support medication review and management, reducing reliance on individual clinicians in a busy, rotating workforce.