ImPE

Adverse drug reactions (ADRs) are common in the elderly - they are prescribed large numbers of medications - with increased risk of due to multiple co-morbidities, reduced physiological reserves and altered drug handling.  Common ADRs are falls, sedation, cognitive impairment which links the topic to major national agenda items such as falls, depression, and dementia. Adverse drug reactions have a major impact on the NHS and population health, accounting for 6% of all hospital admissions, 4/100 hospital bed days and costs of £380 - £466 million a year ^1-3.

Finally, the current work going on within the acute medical unit at Hammersmith Hospital (as per of the ImPE project), has reiterated the above problems in relation to polypharmacy, inappropriate prescribing and ADRs in the elderly. We believe we have created a sustainable system of medication review within the unit to help reduce the above and would like to implement this system within the remaining hospitals within Imperial College Healthcare NHS Trust (Charing Cross and St. Mary's).

The aim is to reduce the burden of adverse drug reactions and consequent health problems in the elderly by implementing the new evidence based medication review system (based on the STOPP tool ⁴). 

Objectives will include

(1) Increased occurrence of medication review

(2) Reduction in the use of inappropriate medication

(3) Increased knowledge and confidence amongst staff in carrying out medication review, (4) Assurance to organisation(s) that medication review is occurring to appropriate standard including agreement on triggers for Medication Review

(5) Empowerment of patients/relatives/carers with information about medications by using the ‘Medication Passport' and other new initiatives.

The project team will judge any improvement by:

• Ensuring that increasing number of patients get a medication review (using the new evidence based STOPP tool). The ultimate aim is to drive this to 100% using standard quality improvement methodology recommended by NIHR CLAHRC).
• Identifying the number of patients for whom medications were stopped and the number of medications stopped.
• Ensuring medication changes are documented in the patient's medical record and communicated at all interfaces.
• Ensuring that all elderly patients (and their families/advocates) get information about medication in the form of a ‘Medication Passport' at the very minimum
• Increased staff awareness, knowledge and confidence in relation to medication review by using staff surveys and other quantitative research techniques
• Increasing sustainability scores over the duration of the project

• The Medication Review System will be implemented at Charing Cross and St. Mary's hospitals' using methodology based upon that developed in the ImPE project.
• In addition we will develop and produce a patient digital story for the purposes of staff awareness and education.
• A planned awareness campaign will be implemented which will include posters, teaching sessions, regular newsletters and baseline staff and patient surveys to engage all involved. This will exploit any existing staff awareness systems.
• An education programme that will include tailored formal group teaching as well as 1:1 interventions when required to increase knowledge and confidence in carrying out medication review. This will exploit any existing staff training systems.
• Regular progress feedback (re: parameters described above) to facilitate improvement

All the above carried out within the theme of quality improvement, specifically using quick PDSA cycles to monitor, implement changes and achieve sustained improvements.