Deprescribing admission medication at a UK teaching hospital; a report on quantity and nature of activity
Background Deprescribing medication may be in response to an adverse clinical trigger (reactive) or if future gains are unlikely to outweigh future harms (proactive). A hospital admission may present an opportunity for deprescribing, however current practice is poorly understood. Objective To quantify and describe the nature of deprescribing in a UK teaching hospital. Method Prescribing and discontinuation data for admission medication from a hospital’s electronic prescribing system were extracted over 4 weeks. The rationale for discontinuation of a random sample of 200 was determined using medical records. This informed categorisation of deprescribing activity by clinicians into ‘proactive’ or ‘reactive’. Data were extrapolated to estimate the proportion of admission medications deprescribed and the proportion which were reactive and proactive. Results From 24,552 admission medicines, 977 discontinuations were recorded. Of the 200 discontinuations sampled for review, only 44 (22.0%) were confirmed deprescribing activities; categorised into 7 (15.9%) proactive and 37 (84.1%) reactive. Extrapolation yielded 0.6% (95% CI 0.5–0.7%) of all admission medications deprescribed. Conclusion Limited deprescribing activity, dominated by reactive behaviour was identified, suggesting prescribers require a clinical trigger to prompt deprescribing. There may be scope for increasing proactive deprescribing in hospital, however the extent to which this is feasible is unknown.
KeywordsDeprescribing Discontinuation Inappropriate medication Medication review Medicines optimisation Polypharmacy United Kingdom
The research team thank the Pharmacy Department at the Norfolk and Norwich University Hospital for assisting with electronic data collection.
The research was funded by Pharmacy Research UK (Personal Research Award No.: PRUK-2017-PA2-A).
Conflicts of interest
The authors declare that they have no conflict of interest.
- 1.Royal Pharmaceutical Society. A Competency Framework for all Prescribers [Internet]. 2016. https://www.rpharms.com/Portals/0/RPSdocumenlibrary/Openaccess/Professionalstandards/Prescribingcompetencyframework/prescribing-competency-framework.pdf. Accessed 9 May 2018.
- 2.Ní Chróinín D, Neto HM, Xiao D, Sandhu A, Brazel C, Farnham N, et al. Potentially inappropriate medications (PIMs) in older hospital in-patients: prevalence, contribution to hospital admission and documentation of rationale for continuation. Australas J Ageing. 2016;35(4):262–5.CrossRefGoogle Scholar