Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.

Join

Subscribe or Register

Existing user? Login

Medicines optimisation

Time to stop

Pharmacists need to be bolder when it comes to recommending that unnecessary medicines be stopped in elderly patients.

Hands of an elderly woman

Source: Nadezda Cruzova / Shutterstock.com

How often would you say that prescribers routinely consider stopping prescribed medicines, particularly for elderly patients? How often do pharmacists think about prompting prescribers to do this? An ageing population means that potentially inappropriate medication may affect more patients. Polypharmacy increases the risk of side effects and drug interactions, and non-adherence leads to falls, hypoglycaemia and unnecessary hospital attendances, for example.

Pharmacists should be braver in prompting doctors to review the need for medicines periodically. We have formed this opinion based on work producing a ‘STOPIT’ tool, developed with the Collaboration for Leadership in Applied Health Research & Care (CLAHRC) for north-west London, which aids medicines reviews, with a particular focus on older patients[1]. Changes made to medicines can be simple, for example, withholding, reviewing and then stopping long-standing quinine sulphate treatment for night cramps, and stepping down proton pump inhibitor treatment in the absence of a clear indication. A specific example is a patient who is over 100 years old and was admitted to our elderly care rehabilitation unit on 12 long-standing medicines. By stopping five of these during an early consultation, in accordance with her physiological status and her preferences, her pill-burden was reduced by eight tablets a day, equating to 3,000 tablets a year.

This intervention also has the potential to reduce the incidence of side effects, reduce medicines waste and improve patients’ experiences with medicines. Reviewing and stopping medicines will contribute to the national agenda on improving patient safety. In the example patient, savings were estimated to be around £250 per year in medicines costs alone, which highlights the opportunities available for pharmacists to help optimise medicines and bring additional financial benefits.

The STOPIT initiative quickly prompted a change in our mindset, not just critically reviewing a medicines regimen during consultations and ward rounds, but also evaluating which medicines may be inappropriate. We would like to see doctors and pharmacists everywhere adopting this mindset.

Often pharmacists might be hesitant to encourage doctors to review medicines because they may fear something going wrong, be concerned about upsetting the patient, not want to question what another clinician has prescribed, or not have enough time to follow up changes. We recognise that a good relationship and communication between doctors and pharmacists is important in order to maximise the benefits of reviewing and stopping medicines, but pharmacists could also be a bit bolder.

Pharmacists should be encouraged to reflect on their own approach to reviewing medicines and recommending those that might be stopped. It is not always complicated and the benefits are potentially far-reaching.

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 here are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2014.20066428

Readers' comments (3)

  • Which tablets did you stop and why?

    I tried to discuss stopping some medicines with a GP for a palliative care patient with swallowing difficulties - the GP was not even open to the possibility of stopping the statin

    Unsuitable or offensive? Report this comment

  • I agree with Fiona. There is the obvious one to consider stopping such as quinine (as clearly advised by the BNF) but how about others? Is there a guideline/framework available?

    Unsuitable or offensive? Report this comment

  • Robin Conibere

    To the 2 commentors above have a look at the references! http://www.clahrc-northwestlondon.nihr.ac.uk/inc/files/documents/newsletters/cw__medication_review_tool_v2.pdf and http://patientsafety.health.org.uk/sites/default/files/resources/the_improving_prescribing_for_the_elderly_project.pdf

    Unsuitable or offensive? Report this comment

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete
  • Print
  • Share
  • Comment
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

Supplementary images

  • Hands of an elderly woman

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.