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Pharmacists of the future need to prompt doctors to review and stop unnecessary medicines

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By Barry Jubraj, Shreena Patel and Emily King

During our undergraduate summer placement at the Chelsea & Westminster Hospital, we saw the use of a medication-review tool on a rehabilitation ward. It’s called ‘STOPIT’ - the ‘Screening Tool for Older Peoples potentially Inappropriate Treatment’.  It was designed by a group called CLAHRC NWL (Collaboration for Leadership in Applied Health Research and Care for north-west London). STOPIT helps doctors and pharmacists to identify medication-related problems and optimise treatment. For example, we saw a patient’s buprenorphine patches being stopped, so we also changed their laxative to from regular to prn, as the side effect of constipation may no longer be an issue. We also saw that the team had stopped a patient’s furosemide, as the patient had a fracture after having a fall, and the diuretic may have been partly responsible for this fall. The ward round felt very personal and logical with continuous reassurance for both the patient and family members.

As future pharmacists it is easy to assume that this type of medication optimisation takes place all the time, but in reality it does not. Pharmacists, doctors and students are so used to seeing the same cocktail of drugs in older patients that they often fail to question indications and current clinical need. Whether taking part in a hospital ward round, or completing a medicines use review in the community, pharmacists of the future need to be reflective and analyse each patient and their list of medications. Do they really need all those drugs?

Without the use of STOPIT there is risk that the patient’s treatment could fall into a vicious cycle. For example, antidepressant therapies may not always be reviewed appropriately. This can have detrimental effects on the elderly. Studies have shown that there is an increased risk of falls due to the side effects of dizziness and unsteadiness. We ask the question – if the depression was stabilised, could an appropriate trial withdrawal have been attempted?

Recently, one of us encountered a relative passing away due to a cardiac arrest subsequent to a hip fracture. We reviewed the medication and it became apparent that there were a number of drugs that could have contributed to the fall, so we will always wonder if STOPIT could have been used to prevent this.

We feel that STOPIT has the potential to increase patient adherence to medication by reducing the pill burden, and reducing the incidence of medication-related problems. In the current economic climate, this may be a cost-effective strategy.  For the elderly, and with the recent increase of mental health issues such as dementia and memory loss, the difficulty of taking various medications could be lessened, reducing the risk of side effects and missed doses.

Finally, do not be afraid to voice your opinion or ask even the most basic of questions as a pre-registration or junior pharmacist. We aren’t to assume it is only a doctor’s job to optimise a patient’s treatment, but it is a duty of ours as the pharmacists of tomorrow to implement the principles of STOPIT in a wider setting.  The rehabilitation consultant told us ‘we each have expertise to bring to the table; if we work together we can achieve great things. Team work is vital for success.’

Disclaimer: This article presents independent research commissioned by the National Institute for Health Research (NIHR) under the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) programme for North West London. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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From: Tomorrow's pharmacist blog

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