7ESSENTIAL PHARMACY ROLE IN POLYPHARMACY REVIEW AND DEPRESCRIBING FOR FRAIL OLDER PATIENTS

Abstract

The Emergency Frailty Unit (EFU) team of clinicians at the Royal Gwent Hospital (Newport) extended their services to the admission department to optimise referrals and reduce the length of stay of frail older patients. Over a period of 6 weeks a multidisciplinary approach was adopted and a pharmacist independent prescriber joined the team of clinicians at the admissions department to undertake a medication review on those newly admitted patients. People who are frail are particularly vulnerable to the effects of polypharmacy due to co-morbidity and age related changes and are at higher risk of adverse drug events (ADE) and non-adherence. A core component of the comprehensive geriatric assessment (CGA) is the medication review with goals of identifying inappropriate prescribing and preventing potential ADE. Incorporating pharmacist expertise is essential to complete the CGA and to review each medication for appropriateness. The pharmacist offered a systematic approach to deprescribing after completing an indepth medication history and reviewing each medication for indication, compliance, side effects and interactions incorporating patient preferences and choices. During this study 116 frail patients had a medication review. 69 patients were reviewed separately in the traditional manner achieving a 48% deprescription rate. The remaining 47 received an in-depth joint multidisciplinary review at admission, resulting in 72% having medications stopped; therefore achieving a 50% higher deprescription rate than if done separately at a later time. A cost avoidance of more than 15,000 per year was achieved during this period. Reducing polypharmacy in frail populations demands an interdisciplinary teamwork. Time constraint was one of the biggest limitations preventing the pharmacist and the medical team from doing a joint multidisciplinary comprehensive review. In view of the results it was recommended for a pharmacist to join permanently the frailty admission team.