STOPIT: Deprescribing tool

Supporting patient safety with effective prescribing

The effective prescribing of medicines ensures that we support the safety and quality of life of our patients.

With the quality improvement team, John Biddulph, chief pharmacist, Shirley Ip, lead pharmacist for frailty, and Ganesh Arunachalam, registrar in elderly care, are working to improve the way that we prescribe medicines to our patients. The medicines optimisation project is focusing on:

Ensuring that our patients take their medicines correctly Ensuring that our patients are involved in decision making Preventing our patients from taking unnecessary medicines Reducing the wastage of medicines Improving the safety practices around the prescription of medicines

In particular, during consultations with your patients, please ensure that you carry out a review of their current medication and discuss if they feel any medicines are no longer benefiting them or are no longer suitable. We can then work to reduce dosages or remove unnecessary medications from prescriptions. To enable this, we have implemented a tool called STOPIT (screening tool for older people’s inappropriate treatment) for clinicians to use when considering deprescribing medication. This is available via a paper form which has been provided to wards. The pilot is underway on Lister Ward and Ray Ward, with an initial rollout programme planned on all medical inpatient wards with a high population of older patients. To date, the roll out of STOPIT on Lister Ward has showed a 22.5% reduction in regular medication on patients’ prescriptions on discharge from hospital (74 medication reductions over 38 patient reviews).

Patients who may particularly benefit from this include multimorbidity patients (those who have two or more long-term health conditions), polypharmacy (those who are taking multiple medications long-term), older people, patients who are housebound or care home residents, patients who have a shortened life expectancy or are receiving end of life care, vulnerable patients, and those with a decline in renal (kidney) function.

Additionally, please discuss any

new and existing medicines on your patients’ prescriptions with them, ensuring that you check that they understand the instructions for how and when to take their medication. When your patients attend for pre-assessments or outpatient appointments, please also remind them which medicines they will need to bring with them for their outpatient procedure or inpatient stay.

This links with a wider programme of work across our partner organisations in the Hertfordshire and West Essex integrated care system (ICS) and a global focus on improving medication practices as part of the World Health Organisation (WHO) Global Patient Safety Challenge:

Medication Without Harm. Please look out for further updates on the medicines optimisation project via this newsletter, In Touch magazine, magazine, the newsletter, the executive team briefing, and the intranet. You can also contact john.biddulph@nhs.net, shirley.ip@nhs.net, or ganesh. arunachalam@nhs.net for more information.