Short Life Working Group On Prescription Medicine Dependence And Withdrawal: consultation

This consultation seeks views on the draft recommendations from the expert Short Life Working Group convened to make recommendations on addressing prescription medicine dependence and withdrawal.

Annex D - 7 Steps to Appropriate Polypharmacy

Pictogram of the 7 Step Polypharmacy process, putting what matters to the patient at the centre.
Domain Steps Process
Aims 1. What matters to the patient? Review diagnoses and identify therapeutic objectives with respect to:
  • What matters to me (the patient)?
  • Understanding of objectives of drug therapy
  • Management of existing health problems Prevention of future health problems
Need 2. Identify essential drug therapy Identify essential drugs (not to be stopped without specialist advice):
  • Drugs that have essential replacement functions (e.g. levothyroxine)
  • Drugs to prevent rapid symptomatic decline (e.g. drugs for Parkinson’s disease, heart failure)
3. Does the patient take unnecessary drug therapy? Identify and review the (continued) need for drugs:
  • With temporary indications
  • With higher than usual maintenance doses
  • With limited benefit in general for the indication they are used for
  • With limited benefit in the patient under review (See: Drug Efficacy (NNT) table page 53)
Effectiveness 4. Are therapeutic objectives being achieved? Identify the need for adding/intensifying drug therapy in order to achieve therapeutic objectives:
  • To achieve symptom control
  • To achieve biochemical/clinical targets
  • To prevent disease progression/exacerbation
Safety 5. Does the patient have ADR/Side Effects or is at risk of ADRs/Side Effects?
Does the patient know what to do if they’re ill?
Identify patient safety risks by checking for:
  • Drug-disease interactions
  • Drug-drug interactions (see Cumulative Toxicity tool page 22)
  • Robustness of monitoring mechanisms for high-risk drugs
  • Drug-drug and drug-disease interactions
  • Risk of accidental overdosing (Yellow Card Scheme)
Identify adverse drug effects by checking for
  • Specific symptoms/laboratory markers (e.g. hypokalaemia)
  • Cumulative adverse drug effects (see Cumulative Toxicity tool page 22)
  • Drugs that may be used to treat ADRs caused by other drugs
(Sick Day Rule page 49 guidance can be used to help patients know what do with their medicines if they fall ill)
Cost-effectiveness 6. Is drug therapy cost-effective? Identify unnecessarily costly drug therapy by:
Consider more cost-effective alternatives (but balance against effectiveness, safety, convenience)
Patient centeredness 7. Is the patient willing and able to take drug therapy as intended? Does the patient understand the outcomes of the review?
  • Does the patient understand why they need to take their medication?
  • Consider Teach back
Ensure drug therapy changes are tailored to patient preferences
  • Is the medication in a form the patient can take?
  • Is the dosing schedule convenient?
  • Consider what assistance the patient might have and when this is available
  • Is the patient able to take medicines as intended?
Agree and Communicate Plan
  • Discuss with the patient/carer/welfare proxy therapeutic objectives and treatment priorities
  • Decide with the patient/carer/welfare proxies what medicines have an effect of sufficient magnitude to consider continuation or discontinuation
  • Inform relevant healthcare and social care carers change in treatments across the care interfaces
Add the READ code 8B31B to the patients record so that when they move across transitions of care it is clear their medication has been reviewed



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