Polypharmacy Review V4.2

START HERE --> Outstanding Medication Reviews (Right-click and Edit to complete)

< "1/1/1800"'> All Repeat Medication Review Records in Descending order Where REVIEW_DAT < "1/1/1800"

ONLY ADD A NEW POLYPHARMACY REVIEW IF THERE ARE NON ABOVE TO COMPLETE

<Click here for guide to completing the Guideline>

Click to add a new Polypharmacy Review

<Polypharmacy Review>

CLICK HERE TO VIEW DIAGNOSES AND REPEATS, CLICK AGAIN TO HIDE

Significant Diagnoses
All Medical History Records in Descending order Where PRIORITY = "1 " OR PRIORITY = "2 "
Last 3 Months Acute Therapy Issues
>= "T-3m" AND ISSUE_NO <= "1"'> All Acute and Repeat Issue Therapy Records in Descending order Where EVENTDATE >= "T-3m" AND ISSUE_NO <= "1"
Active Repeats
All Repeat Masters Records in Descending order Where INACTIVE = "N "

Rockwood Clinical Frailty Scale (last 3 recorded)

1-3 = Fit / Managing, 4-5 = Mildly Frail, 6 = Moderately Frail, 7-9 = Severely Frail.
Where applicable, it should be repeated every 6-12 months - use button below to record new score if needed
Last 3 Scoring Test Result Records Where READ_CODE = "38DW"
<Rockwood Clinical frailty Scale>

1. What matters to the individual about their condition(s)?

Review diagnoses and identify therapeutic objectives and potential to prevent future health issues. All medicines and lifestyle advice should be prescribed for a specific indication which should be documented in the patient's record.
<Indication for each drug checked> <Medicine adherence good> <Medicine adherence poor> <Lifestyle advice given>

2. Identify essential drug therapy (not to be stopped without specialist advice)

Drugs that may cause rapid symptomatic decline or loss of disease control if discountinued abruptly or changes that would normally involve a prescriber that specialises in this field. Document any changes using options in Section 3.
Text1.bmp
<Specialist advice>

3. Does the individual take unnecessary drug therapy?

Identify and review the (continued) need for drugs with: specific stop dates, temporary indications, higher than usual maintenance doses, limited benefit/evidence.
Changes to guidelines and individual health can mean a medicine is no longer appropriate. This includes disease-drug and drug-drug interactions. Also consider OTC medicines.
<Medication satisfactory> <Medication changed> <Medication stopped> <Medication commenced>

4. Are theraputic objectives being achieved and has all appropriate monitoring been undertaken?

Identify the need for adding / intensifying / changing drug therapy in order to achieve therapeutic objectives regarding symptom control, biochemical/clinical targets, prevention of disease progression/exacerbation.

CLICK HERE TO VIEW RECENT LAB RESULTS AND EXAMINATION FINDINGS, CLICK AGAIN TO HIDE

Test Results
Test Results>1D 002dVSodium 002WVPotassium 0024VSerum creatinine 00?MVGlomerular Filtration Rate 001vVAspartate Aminotransferase 001uVAlanine Aminotransferase 001xVBilirubin 0047VHb A1C - Diabetic control 0022VSerum cholesterol 002FVLow Density Lipoprotein 001zVCalcium adjusted 00?4VAlbumin Creatinine Ratio 008zVFree Thyroxine 002mVThyroid Stimulating Hormone 0029VSerum ferritin 001wVB12 Levels 002?VFolate level 002BVHaemoglobin 002MVMean corpuscular volume 002VVPlatelets 008uVFEV1/FVC
Examination Findings
Examination Findings>1D 001DVWeight 000sVBlood pressure
<Efficacy of all medication checked> <Monitoring up to date> <Monitoring required - add test details in comments>

5. Does the individual have or is at risk of adverse drug reactions or side effects, and know what to do if they are ill?

Identify safety risks by checking for: appropriate treatment targets (e.g. HBA1c, BP etc), drug-disease and drug-drug interactions, robustness of monitoring for high-risk drugs, risk of accidental overdose.
Identify adverse drug effects by checking for: specific symptoms/laboratory markers (e.g. hypokalaemia), cumulative adverse drug effects and drugs that may be used to treat ADRs caused by other drugs.
<Adverse reaction to drug> <At risk of adverse drug reaction>

6. Is the drug therapy cost effective and environmentally sustainable?

Identify unnecessarily costly drug therapy by considering more cost-effective / sustainable alternatives (but balance against effectiveness, safety, convenience).
Consider environmental impact e.g. of inhaler use, single use items, medicines waste and water pollution.
<Yes> <No>

7. Is the patient person willing and able to take drug therapy as intended?

Discuss and agree therapeutic / lifestyle priorities, objectives and changes with thet individual / carer - do they understand and are willing to take all forms / frequencies of drugs? Is any assistance needed?
Look for regular ordering of repeat / serial prescriptions at expected intervals. Inform relevant health / social care providers of needs / changes.
<Yes> <No> <Uses monitored dosage system (MDS)> <MAR (Medication administration record) chart>

Record Eadon Score 1-6 (for use if needed to record level of impact of intervention)

Detrimental to patient well-being = 1 Significant: improvement in the standard of care = 4
Not significant to patient care = 2 Very Significant: prevents major organ failure / adverse reaction / similar importance = 5
Significant: NO improvement in patient care = 3 Potentially Life Saving = 6
<Eadon Score>

Any further referral necessary?

<Referred to pharmacist> <Referred to GP> <Other referral>

Guideline information - click to expand

Revision 4.2
Requested by Lucy Dixon
Created 18/04/2024 by NHS Highland eHealth Facilitators
nhshighland.ehealthfacilitators@nhs.scot
Vision DLM800