1. Polypharmacy and preventing hospital admissions
Francesca Aaen
Care Homes Pharmacist
NHS Lanarkshire

2. Lots of possible side effects Lots of possible interactions
POLYPHARMACY
Lots of medicines
Lots of possible side effects
Lots of possible interactions

3. POLYPHARMACY Probably been on a lot of the medicines for a long time
Some medicines may be to treat the side effects of other medicines
Some of the conditions treated may not be a problem any more
A real problem for the frail/elderly

4. FRAIL or ELDERLY More susceptible to the side effects of medicines
Reduced renal function
Reduced clearance of medicines
Co-morbidities
You don’t have to be elderly to be frail!

6. High Risk Combinations Drugs Which Are Poorly Tolerated In The Elderly
Drugs Commonly Associated With Admissions Due To Adverse Reactions
Orthostatic Hypotension
Drugs With Shared Side-effects
Diabetic Treatment
Antipsychotic Medication In Dementia
Laxatives
General guidance is given on the use of medicines within this list in the frail/elderly on the risks associated with polypharmacy.

7. Polypharmacy review
Consider every patient individually and holistically
Ensure that every medicine prescribed has a relevant and current indication
What is the patient experience?
Consider drug effectiveness i.e. NNTs
Is the dose appropriate?
Dosing form and schedule appropriate?
Cost-effective prescribing
Housekeeping
What we would do?
Holistic polypharmacy review
Make sure all current indications are appropriately treated
Consider adverse effects and potential adverse effects
Check all recent test results
Consider antihypertensives – is BP over treated now?
Consider Adcal, is it indicated and would the patient comply
NNT – drug effectiveness summary is included in the guidance e.g. NNT for statins Post Stroke [Atorva 80 v Placebo]=165
To avoid One Cardiovascular Event with No difference in Mortality to 5 years
Dosing …consider renal failure

8. Why will this help prevent hospital admission?

9. SPARRA Scottish Patients at Risk of Readmission and Admission
Predicts an individual's risk of being admitted to hospital as an emergency inpatient within the next year
Predictive criteria includes polypharmacy

10. Adverse Drug reactions
Cause 5% of all hospital admissions
Bleeds
Renal failure
Drug toxicity
Falls

11. Reducing inappropriate polypharmacy will reduce risk of adverse drug reaction
Reduced avoidable hospital admissions and improved quality of life