31 * THE IMPACT OF A REGULAR MULTIDISCIPLINARY MEDICATION REVIEW ON POLYPHARMACY AND PSYCHOTROPIC PRESCRIBING IN CARE HOME RESIDENTS-A FOLLOW-UP STUDY

Abstract

Introduction: Polypharmacy (defined as the use of multiple medications) is common in elderly care home residents. It is a challenge to balance adherence to guidelines for chronic disease management and the perils of adverse drug effects. In 2009, we introduced a weekly multidisciplinary medication review of our care home residents. Within four months there was a reduction in the average number of psychotropic drugs from 2.3 per patient to 1.7. The total number of medications per patient reduced from 7.1 to 6. Antidepressant prescribing reduced from .7 per patient to .2. The aim of this audit was to assess whether this intervention had a long term effect in maintaining the initial improvements. Method: A clinical pharmacist, clinical nurse manager and specialist geriatrician meet weekly to review residents' medication. In September 2013 the total number of medications and psychotropic medications ( British National Formulary classification) per resident was collected. Laxatives and dietary supplements were excluded. The consumption of as required' medication was included if administered within the past 72 hours. Results: Total number of residents was 54. Mean age was 80.2 years (55.6% female). 81.5% had cognitive impairment (MMSE <26/30), while 27.8% had severe cognitive impairment (MMSE <10/30). Total number of medications prescribed was 6.8 compared with 7.1. There was a small reduction in psychotropic prescribing 1.35 per patient compared to 1.7. Antidepressant prescribing was increased at 0.277 per patient compared with .2. Conclusion: This study demonstrates the continued positive impact of regular multidisciplinary medication review meetings on the prescribing of psychotropic medications, and in maintaining reductions in total number of medications for our long term elderly residents. Polypharmacy remains high with an average number of medications of 6.8. It is imperative to continue to implement strategies to promote appropriate, individualised prescribing in this at risk vulnerable population.