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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

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



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