Abstract
Background
Frail older patients are at increased risk of adverse drug events due to polypharmacy and age-related pharmacokinetic changes. Standardised Medication Reviews (SMRs) are essential for optimising prescribing, reducing harm, and improving outcomes as part of comprehensive in-patient geriatric assessments. However, both inconsistent documentation and data capture limit their effectiveness. The implementation of an electronic prescribing platform within our organisation enables real-time SMR documentation and creates opportunities for service improvement.
Methods
In alignment with national standards and best practices, a standardised approach to medication reviews was implemented across our Medicine for the Elderly wards. A collaborative, multidisciplinary team of doctors and clinical pharmacists conducted SMRs during ward rounds, promoting person-centred care in the process. A structured SMR documentation template was embedded within the electronic prescribing system. Key performance indicators (KPIs), clinically relevant to our patient population, were co-produced by the clinical team. Monthly data were extracted from the system, including the number of SMRs, optimisation interventions, formulary switches, and prescribing trends related to the KPIs.
Results
Over a 12-month period, 1,672 medication reviews were undertaken. The median number of medication optimisations was 591 per month. Atorvastatin and proton pump inhibitors (PPIs) were the most optimised medication groups. Formulary switches for direct oral anticoagulants (DOACs) were measured to ensure optimal prescribing practices. Data were also collected on de-prescribing high-cost, low-value medications, such as lidocaine 5% plasters, with an average of 5.5 prescriptions stopped each month.
Conclusion
Embedding standardised medication reviews within the electronic prescribing platform enables consistent documentation and reliable communication, supports data-driven quality improvement, and promotes safer prescribing for frail older adults. This scalable approach aligns with national priorities for medicines optimisation in older populations. Our target for this financial year is to complete 2,500 SMRs within our Acute Medicine for the Elderly in-patient population.