Strategies to Improve Medication Safety and Reduce Harm in Polypharmacy

Celina B
Polypharmacy

In our previous blog, we discussed high-risk situations arising from look-alike, sound-alike (LASA) medications and high-alert medications which can cause significant medication harm. In this blog, we will talk about how to improve medication safety and adopt strategies to reduce polypharmacy, a term that refers to the use of multiple medications at the same time by one person.


Medicines can provide many benefits in treating and preventing health problems. However, at times polypharmacy can be inappropriate.
For example, people may still be taking medicines that are not working or no longer needed; medicines may have been prescribed to treat the side effects of other medicines or other treatment options which might lead to severe side effects or harm. Elderly people with multiple chronic diseases are the most vulnerable group in polypharmacy.

Statistics on Impact of Polypharmacy

Inappropriate polypharmacy is one of the most significant public health issues facing us today, especially amongst the elderly. Polypharmacy increases medication safety risk due to the likelihood of side effects, risk of interactions between medications and making medicine adherence more difficult. This challenge is set to increase as the population ages (in some countries) and more people suffer from multiple chronic diseases. 

 

The depth and breadth of polypharmacy’s impact on are highlighted in the following statistics:

50% of hospital admissions due to Adverse Drug Events (ADEs) are preventable. 70% of these are inpatients over 65 years of age and on 5 or more medicines.

67% of elder people are taking five or more prescription drugs, over-the-counter medications, and supplements

Polypharmacy increases the risk of ADEs, from 13%, which is associated with taking two medications, to 58%, which is associated with five drugs

8.6 million unplanned hospital admissions were caused by ADEs in Europe every year. 70% of these inpatients are over 65 years of age.

Risks and Challenges due to Polypharmacy

In general, the issue of polypharmacy mainly revolves around the elderly (65 years of age and above). Let us review some of the commonly discussed challenges, including adverse effects, medication adherence issues, and most recently the impacts of the COVID-19 pandemic.

    • ● More medication means a more complex dose schedule as well. Even if patients use a calendar to schedule dose intake, they may still experience occasional poor compliance or confusion with multiple doses.

    • Side effects associated with polypharmacy can create issues with adherence compliance. If a patient is taking medication that causes fatigue, they could sleep through the dosing period. Also, some medications may even cause memory loss in patients leading to double dosing (overdose).

    • Prescribers have tools that can help predict possible adverse drug reactions between medications, they often don’t make up for the fact that polypharmacy raises the risk that medications taken together will lead to potentially harmful interactions.

    • Some medications come with lengthy instructions that spell out the amount of medicine to take, how to take it, frequency of intake, and when not to take the drug so patients have the potential for getting confused due to such LASA drugs.

    • COVID-19 pandemic has taken a significant toll on people, which has translated to substantial increases in medication use. For instance, consumer use of antidepressant, anti-anxiety, and anti-insomnia medications increased the risk of medication errors due to polypharmacy.

Strategies and Tools to Reduce Polypharmacy

The healthcare industry has made significant collective efforts to develop tools that can help tackle the challenges inherent to polypharmacy. The following are some of the strategies and tools your organization can adopt to reduce polypharmacy, increase deprescribing, and help patients achieve substantial clinical and financial benefits.

1. Deprescribing

Deprescribing is considered one of the most effective ways to decrease polypharmacy. It is the planned and systematic process of identifying and reducing or discontinuing medications that may no longer be of benefit or may be causing harm. The main goal is to reduce the potential adverse effects of polypharmacy. This is achieved by multidisciplinary team collaboration and addressing the patient’s current needs and goals of care.

2. MAI Index

The Medication Appropriateness Index (MAI) is a set of 10 questions conceived to help clinicians make deprescribing decisions. Each criterion is rated on a three-point Likert scale. When added up, the resulting score is intended to determine the level of inappropriateness, with a score of 0, meaning the drug is appropriate, and 18 representing maximal inappropriateness.

3. Beers Criteria

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, are guidelines published by the American Geriatrics Society (AGS) for healthcare professionals to help improve the safety of prescribing medications for adults 65 years and older in all except palliative settings. The Beers Criteria are intended to serve as a guide for clinicians and the criteria may be used in conjunction with other information to guide clinicians about safe prescribing in older adults.

4. STOPP/START Criteria

These two resources — the screening tool of older people’s prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria — were first published in 2008 and most recently updated in 2014. The latest versions of STOPP and START include a combined 114 evidence-based criteria — up more than 30% from the original. With the STOPP/START criteria, clinicians can potentially decrease polypharmacy by improving medication appropriateness

5. SIMPATHY Analysis Tool

The goal of the SIMPATHY economic analysis tool is to provide a high-level analysis of the economic costs and benefits associated with carrying out polypharmacy reviews. The analysis follows a top-down approach and estimates maximum costs and benefits associated with activity.

Sources: Adopted from WHO, NCBI, AGS and European Commission

Conclusion

Hospital management plays a significant role in reducing inappropriate polypharmacy and ensuring medication safety. Taking a systems approach with multidisciplinary clinical and policy leadership is good starting point. Nurture a culture that encourages and prioritizes medication safety in your organization. Streamline and standardize your policies, procedures, and protocols as these are critical in managing polypharmacy risks. This applies from initial prescribing practices to regular medication reviews.
 

Adopt one or more of the strategies described above to reduce polypharmacy. Deprescribing is one of the most effective ways. Using tools and technology appropriately to support implementation can be useful and effective. This includes having an online reporting system for medication error reporting. Finally, educate and empower your patients with the right information to make informed decisions. This can go a long way in ensuring the safe use of medicines.