Who is this guideline targeted at?

Everyone, including patients, policy makers and healthcare professionals, has a role to play in ensuring that when polypharmacy is used it is safe and appropriate. This guideline aims to provide resources, expertise and insight for all involved with polypharmacy management, despite the need for far more published research. It will take all members of the healthcare team to bring about significant improvement in this area, and utilising the multidisciplinary team for more complex interventions should be considered.

The core foundation of Polypharmacy Guidance, Realistic Prescribing 2018 approach remains the holistic patient centred 7-Steps medication review. However, once embedded, the principles should be considered at all critical stages of the medication use process: prescribing; reviewing; dispensing; communicating and reconciling. This is of particular importance at initiation of treatment in order to support shared decision making between the patient (and/or carers, and/or welfare proxies) and clinician.

Patients play a vital role if provided with the right information, tools and resources to make informed decisions about their medicines. Although many of the resources provided are aimed at clinicians, an App, patient leaflets and revised Sick Day Rule guidance will be available to aid patient understanding and involvement, in the review and supports shared decision making

Recommended actions for Boards/IJBs

Boards and IJBs should consider this information alongside the data provided by the indicators (Appendix F) and identify a lead within the medicines management team and a local clinical lead, geriatrician or GP. These two leads should work together to drive delivery and implementation of the recommendations within this document, ensuring that the primary and secondary care interface is appropriately developed.

Recommended actions for clusters

Clusters should engage with local medicines management team to review data and consider utilising a quality improvement based approach to deliver change. They should also consider the adoption of Kotter’s framework as set out in the SIMPATHY handbook4 and shown below: