Summary of the example
Developed from the well-known STOPP medication review tool, STOPIT has helped pharmacists and doctors in NW London to systematically review continuing medication in individuals who come into hospital with medicines-related problems (MRPs). Feedback from others suggests that STOPIT is a straightforward tool to use, particularly in the acute setting.
STOPIT has provided opportunities to stop inappropriate medicines in the elderly and prevent further medicines being prescribed to combat current adverse drug events (ADEs). Medication review is already a part of routine clinical work for many healthcare professionals. STOPIT has formalised this existing process in our older patients. Reviewing medicines during an acute admission to the hospital has captured patients who may otherwise not have had the opportunity for review with their GPs or community pharmacies.
STOPIT has been used in a variety of settings, including in older patients in the acute setting, in an older peoples’ rehabilitation setting, and in an older peoples’ outpatient clinic.
Why we think it’s important
Many criteria and tools have been designed to support the process of reviewing medicines, particularly with increasing problematic polypharmacy. STOPP/START criteria are excellent and successfully identify medicines that may be inappropriate. However, the publication describing it and appendixes are long so we wished to produce a shorter, practical tool.
This STOPIT example came out of a wider project and since implementation in 2013 has lent itself well to an acute setting for its ease of use, embedded with a robust project management strategy. It includes consistent BNF wording, contains major headings including falls, confusion, metabolic side effects, constipation and bleeding. It is specific to older people and includes medicines with anti-muscarinic side effects. It has received external feedback that it is particularly straightforward to use. A card has been produced that can be inserted in a security badge lanyard as an aide memoire.
Learn more about the example
Aims and objectives of the work
The project intended to improve health outcomes for older patients by reducing medication burden through a locally implemented evidence-based medicines management strategy that included identifying patients for review and then undertaking a review.
- Develop an effective process for identifying patients with possible MRPs
- Actively manage medicines in older patients by reducing doses and stopping those that are unnecessary
- Communicate effectively to ensure continuity of care across healthcare interfaces
- Empower patients to actively seek review of potentially non-essential medicines
See supporting project report and PDSA cycle documents for details.
A project management strategy was devised with project acceptance criteria defined. The project plan covered May 2012-April 2013. Quality improvement methodology was used including action-effect diagrams, plan-do-study-act cycles, process mapping and stakeholder engagement mapping.
Four main intervention arms were agreed:
- CWH Medication Review Tool
- Training and awareness sessions
- Embedding tools in the local Electronic Prescribing System
- Patient empowerment
In terms of medicines review processes, the STOPIT card is printed on high quality card and provided to pharmacists and doctors on induction. The local ward pharmacy manual includes the expectations of all pharmacists to review medicines in line with all of our quality improvement projects.
- In the original development study (2014), of 76 medication reviews (average 9 medicines per patient), 72% of patients had a medication stopped using the tool
- A reduction in pill burden and medication costs was observed
- In the rehabilitation unit preliminary study, for 36 patients, 42% of patients had at least one prescribed medicine stopped or adjusted by the multidisciplinary team
- In the outpatients preliminary study, out of 101 medication reviews, 24 patients had changes made to one or more medicines (24/101 reviews, 24%)