1052 CLINICAL MEDICATION REVIEWS AND OPTIMISATION FOR INPATIENTS IDENTIFIED AS FRAIL ON THE ELDERLY CARE WARDS AT EAST LANCASHIRE HEALTH TRUST

Abstract

Abstract Introduction Inpatient medication review occurs daily on our elderly wards and NICE (clinical guideline NG5) advocates using a Stopp/Start tool. Polypharmacy and tablet burden are common issues in frail patients and medications should be under regular review. Evidence of these reviews can be laborious to identify in written notes, particularly for frail patients with complex discharges. We aimed to determine whether clinical medication reviews are documented clearly at ELHT and to improve this. Method Patients with a Rockwood frailty score of ≥6 were identified and inpatient notes and charts audited for written detail of medication reviews and drug changes, then compared to the trust Stopp/Start toolkit. Cycle 1 was prior to intervention. We then delivered clinical education on medication optimisation and prompted use of ‘medications review’ proforma on existing trust documents. Cycle 2 occurred after this, then following changeover of junior doctors educational sessions were repeated and cycle 3 data collected. Results 82% of all patients audited had altered medications with a mean hospital stay of 8 days. On cycle 1 65% of patients with altered medications had documentation to explain medication changes, on cycle 2 this improved to 88% and 72% on cycle 3. 92% of patients had a documented medication review (even if this involved no drug changes) at cycle 1 which improved to 100% on cycle 2 and remained at 92% on cycle 3. Both before and after intervention medications were appropriately rationalised or introduced. Conclusion We were already conducting regular reviews and optimising medications for frail patients. Prior to intervention there were inconsistencies on how this was documented. Through education and proforma for documentation this greatly improved, in turn improving communication and continuation of care on discharge. We are introducing electronic records to the trust and aim to include medication reviews into this system.