Realistic Prescribing Pathways and Polypharmacy Workshop, November 2018 Alison Clement & Elaine Ferguson Aims: Share information with key stakeholders Provide the opportunity for a wider discussion of polypharmacy and realistic prescribing pathways Reach a consensus on the value of forming a new group to support appropriate prescribing/de-prescribing across NHS Tayside in line with realistic medicine principles Summary The workshop brought together 40 participants from different areas and disciplines to discuss how the organisation can support a proactive approach to polypharmacy. Participants were unanimously supportive of exploring how to take forward realistic medicine principles within prescribing to promote more holistic, evidence based patient care, but they did not support the formation of a new group to drive this forward. A large amount of feedback and suggestions were generated from the 2 hour workshop, which has the potential to act as a platform for developing an improvement plan to tackle these issues at both strategic and operational levels. To take this forward effectively in a design-led way will require collaborative working and co-production with all stakeholders. Participants were asked “How do our current ways of working in Tayside contribute to or make it difficult to manage polypharmacy?” Themes emerging from the feedback captured: Capacity and capability for medication review IT and tools Clinical governance and risk Engagement, awareness and communication Patient involvement Operating environment / system issues Social prescribing Continuity of care Key stakeholders identified by participants Examples of actions to address polypharmacy suggested by stakeholders Priority actions identified by stakeholders: Tools ready at point of consultation Electronic prescribing in secondary care Public engagement – co-production Care navigation – for non-medicine therapeutic interventions Tackling the culture and clinician / patient relationship to encourage shared decision making “Co-production approach with patient / public” “Integration of tools to provide a point of prescribing flag” “Consistent information to follow the patient” “Care navigation – what alternatives available for individualised care” Outcomes and Next Steps Further work to define the organisation’s strategic approach to realistic medicine in the context of prescribing is required. There is an opportunity to improve communication, engagement and awareness of the risks and benefits of medicines to all stakeholders. Stakeholders are keen to share views and work together to address these issues.