Deprescribing admission medication at a UK teaching hospital; a report on quantity and nature of activity

Scott, Sion ORCID: https://orcid.org/0000-0001-7669-0632, Clark, Allan ORCID: https://orcid.org/0000-0003-2965-8941, Farrow, Carol, May, Helen, Patel, Martyn, Twigg, Michael James ORCID: https://orcid.org/0000-0003-0910-3850, Wright, David John and Bhattacharya, Debi ORCID: https://orcid.org/0000-0003-3024-7453 (2018) Deprescribing admission medication at a UK teaching hospital; a report on quantity and nature of activity. International Journal of Clinical Pharmacy, 40 (5). 991–996. ISSN 2210-7703

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Abstract

Background: Deprescribing medication may be in response to an adverse clinical trigger (reactive) or if future gains are unlikely to outweigh future harms (proactive). A hospital admission may present an opportunity for deprescribing, however current practice is poorly understood. Objective: To quantify and describe the nature of deprescribing in a UK teaching hospital. Method: Prescribing and discontinuation data for admission medication from a hospital’s electronic prescribing system were extracted over 4 weeks. The rationale for discontinuation of a random sample of 200 was determined using medical records. This informed categorisation of deprescribing activity by clinicians into ‘proactive’ or ‘reactive’. Data were extrapolated to estimate the proportion of admission medications deprescribed and the proportion which were reactive and proactive. Results: From 24,552 admission medicines, 977 discontinuations were recorded. Of the 200 discontinuations sampled for review, only 44 (22.0%) were confirmed deprescribing activities; categorised into 7 (15.9%) proactive and 37 (84.1%) reactive. Extrapolation yielded 0.6% (95% CI 0.5–0.7%) of all admission medications deprescribed. Conclusion: Limited deprescribing activity, dominated by reactive behaviour was identified, suggesting prescribers require a clinical trigger to prompt deprescribing. There may be scope for increasing proactive deprescribing in hospital, however the extent to which this is feasible is unknown.

Item Type:	Article
Uncontrolled Keywords:	deprescribing,discontinuation,inappropriate medication,medication review,medicines optimisation,polypharmacy,united kingdom
Faculty \ School:	Faculty of Science > School of Pharmacy Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Science > Research Groups > Patient Care Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research
Depositing User:	LivePure Connector
Date Deposited:	18 Jun 2018 12:30
Last Modified:	24 Aug 2023 04:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/67386
DOI:	10.1007/s11096-018-0673-1

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