Your trust audit shows 35% of 75s are discharged on 10 medications. You've been asked to lead a QI project to reduce inappropriate polypharmacy. Outline your approach.

Question

Your trust audit shows 35% of >75s are discharged on >10 medications. You've been asked to lead a QI project to reduce inappropriate polypharmacy. Outline your approach.

Accepted Answer

I'd structure this as a Model for Improvement project. Aim: reduce mean discharge medication count for over-75s by 20% in six months without increasing 30-day readmission. I'd map stakeholders early — clinical pharmacy, geriatrics, GPs and PCN pharmacists, patient representatives — and convene a small working group. Baseline data from EPMA and benchmarking against PINCER. The intervention would be a structured medication review template anchored to STOPP/START, embedded into the geriatric ward round with a clinical pharmacist, and a 'second pair of eyes' check before discharge summary. I'd run sequential PDSA cycles, starting on one ward, measuring meds count, falls, AKI and readmission as outcome and balancing measures. To sustain I'd write an SOP, build it into junior doctor induction, present at audit and submit to BGS for poster. I'd reflect on what I learnt about leading change across professional groups for my portfolio.

Polypharmacy review service redesign

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