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Complex Medication Review. Robert Hallworth Chair – Greater Manchester Non-Medical Prescribing Network. Oldham Primary Care Trust. The Levels of Medication Review. Level 3 – Clinical Medication Review. Level 2 – Concordance & Compliance Review.

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Complex Medication Review

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Complex medication review
Complex Medication Review

Robert Hallworth

Chair – Greater Manchester Non-Medical Prescribing Network

Oldham Primary Care Trust


The levels of medication review
The Levels of Medication Review

Level 3 – Clinical Medication Review

Level 2 – Concordance & Compliance Review

Level 1 – Prescription Review

Level 0 – Ad Hoc


Medication review particular risk groups identified in older people nsf
Medication Review - particular risk groups identified in Older People NSF

  • Those on 4 or more medicines

  • Post-discharge from hospital

  • In care homes

  • Where medicine-related problems have been identified

  • Patients over 75

  • Following an adverse change in health


Patient cb
Patient CB

  • Paracetamol – under dose?

  • Gaviscon – under dose?

  • Prochlorperazine – under dose? Adverse effects?

  • Propranolol – interaction with diltiazem?

  • Pholcodine – under dose? Adverse effects?


Patient cb1
Patient CB

  • Clopidogrel – indication? Adverse effects?

  • Dilitiazem – adverse effects?

  • Monomax – dose timing

  • Bezafibrate – use with a statin?

  • Quinine bisulphate – indication?

  • Metformin – what is the intended dose?


Patient cb2
Patient CB

  • Lansoprazole Fastabs – Dose. Cost effectiveness

  • Furosemide – indication

  • Nicorandil – is it needed? Adverse effects?

  • Terbinafine – course length

  • Ferrous sulphate – indication. Adverse effects.


Patient rk
Patient RK

  • BP control

  • Diabetes control

  • Weight – orlistat?

  • GI symptoms

  • Nicorandil

  • Lipid modification

  • Smoking

  • Asthma


Patient rk1
Patient RK

  • Angina

  • Depression / mental health

  • Pain

  • Monitoring – BP, HbA1C, BG, U&Es, lipids, LFTs, PEFR


The no tears tool
The NO TEARS tool

Need and Indication

Open questions

Tests and Monitoring

Evidence and Guidelines

Adverse Events

Risk Reduction or Prevention

Simplification and Switches


Questions
Questions?

Thank you

Robert.Hallworth@nhs.net


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