Spotlight issue: Polypharmacy

Polypharmacy is the use of five or more medicines at the same time, including prescription, over-the-counter and complementary medicines.⁶³ Polypharmacy may be necessary and appropriate in certain circumstances, such as in patients with complex medical needs. Monitoring through regular medication reviews will identify potentially inappropriate polypharmacy and its associated risks.

People with intellectual disability with complex health care needs are often at risk of polypharmacy that may result in adverse events, drug interactions and medication-related complications.^64,65,^[69]

Polypharmacy and the inappropriate use of psychotropics for behaviours of concern are also prevalent among people with intellectual disability.^63,64,67

Important NSQHS Actions

Action 4.01	Clinicians use the safety and quality systems from the Clinical Governance Standard when: Implementing policies and procedures for medication management Managing risks associated with medication management Identifying training requirements for medication management.
Action 4.03	Clinicians use organisational processes from the Partnering with Consumers Standard in medication management to: Actively involve patients in their own care Meet the patient’s information needs Share decision-making.
Action 4.06	Clinicians review a patient’s current medication orders against their best possible medication history and the documented treatment plan and reconcile any discrepancies on presentation and at transitions of care.

Action 4.01

Clinicians use the safety and quality systems from the Clinical Governance Standard when:

Implementing policies and procedures for medication management
Managing risks associated with medication management
Identifying training requirements for medication management.

Action 4.03

Clinicians use organisational processes from the Partnering with Consumers Standard in medication management to:

Actively involve patients in their own care
Meet the patient’s information needs
Share decision-making.

Action 4.06

Clinicians review a patient’s current medication orders against their best possible medication history and the documented treatment plan and reconcile any discrepancies on presentation and at transitions of care.

Strategies for Improvement

Strategies to support Actions 4.01, 4.03 and 4.06 include:

Strengthening medication reviews using the best possible medication history. This involves reconciling and confirming medicines with at least two sources and includes a discussion with the person and their family, NDIS service providers and guardian. Medication reviews provide an opportunity to confirm that all currently prescribed medications are still clinically appropriate and effective
Discharge planning, which should commence early into the admission, particularly in relation to medicine management
Handing over medicines information to the GP and to the community pharmacist if required, to facilitate continuity in medication management. For example, blister packs may need to be changed. Early engagement with the hospital or community pharmacy will support continuity of care with medicines upon discharge.

Resources

National Institute for Health and Care Excellence Learning disability: behaviour that challenges quality standard, which includes the following statement:
“People with a learning disability and behaviour that challenges have a multidisciplinary review of their antipsychotic medication 12 weeks after starting treatment and then at least every 6 months.” (Statement 12)
The NHS England STOMP campaign, which attempts to prevent inappropriate polypharmacy with psychotropic medications among patients with a learning disability and autistic people
The Frith Prescribing Guidelines for People with Intellectual Disability, focused on the appropriate prescription and review of medicine for people with intellectual disability
The UNSW 3DN Responsible Prescribing course for health professionals
The World Health Organization report on Medication Safety in Polypharmacy.