Identifying, highlighting and reducing polypharmacy in a UK hospice inpatient unit using improvement Science methods

Area of Science:

• Gerontology
• Clinical Pharmacy
• Palliative Care

Background:

• Polypharmacy, defined as using over ten regular medicines or twenty tablets/capsules daily, is a growing global challenge.
• It is driven by aging populations and multi-morbidity, leading to medication interactions, adherence issues, and increased costs.
• Hospice settings face unique challenges in managing polypharmacy due to complex patient needs.

Purpose of the Study:

• To implement quality improvement methods to reduce polypharmacy in a hospice inpatient unit.
• To decrease the average number of regular tablets/capsules per patient by 25% through targeted interventions.
• To evaluate the effectiveness of specific interventions in managing polypharmacy.

Main Methods:

• Utilized Plan-Do-Study-Act (PDSA) cycles to test interventions.
• Interventions included offering medication withdrawal (e.g., paracetamol), constipation management guides, prescriber education, checklists, and highlighting stickers for polypharmacy review.
• Defined polypharmacy as >10 regular medicines or >20 regular tablets/capsules daily.

Main Results:

• Achieved a 25% reduction in average daily tablet/capsule burden per patient.
• Reduced the average number of regular medications by 16% and liquid medication volume by 30%.
• Trialing medication withdrawal and implementing a laxative guide were effective; highlighting tools improved prescriber awareness.

Conclusions:

• Quality improvement methods can effectively reduce polypharmacy in hospice settings.
• Simple, targeted interventions can significantly decrease medication burden without compromising care.
• The study demonstrated successful implementation of strategies to manage polypharmacy in palliative care.