3737 Improving the appropriateness of inpatient polypharmacy reviews: a three-stage retrospective quality improvement project

Abstract Introduction Inappropriate polypharmacy is the use of medications with no evidence-based indication, unmet treatment goals, high risk of adverse drug reactions, or when the patient is unwilling/unable to take treatment as intended. This is particularly concerning in geriatric care, due to increased risk of hospital admissions, adverse drug reactions and significant healthcare costs. To address these risks, clinicians should conduct patient-focused medication reviews. This project aimed to assess and improve polypharmacy reviews at Royal Albert Edward Infirmary, with a focus on reducing inappropriate polypharmacy and its associated risks. Method Data was collected retrospectively from September 2024, December 2024, and June 2025 (n = 60), using ‘Hospital Information System.’ Demographics included age, sex, clinical frailty score and primary diagnosis. Admission and discharge medications were reviewed, alongside anticholinergic effect on cognition (AEC) scores, documentation of medication changes, patient involvement and formal medication reviews. Interventions included weekly combined doctor-pharmacist ward rounds, electronic deprescribing alerts, and education sessions for doctors. Results Documented deprescribing discussions increased from 0% (baseline Sept 24) to 45% (Dec 24) and then 60% (Jun 24). The proportion of regular medications discontinued rose from 5.4% to 19.3% to 28.6% over the three cycles. Despite these efforts, on average, patients were discharged with a higher number of medications before intervention—initially 9.1 vs 10.3, then 11.2 vs 10.9 post intervention and higher again—9.6 vs 11.0 in cycle three. As a result, discharge AEC scores across cycles one, two and three reflected this, with a 15% increase, 5% decrease and 4% increase, respectively. Commonly deprescribed medications included anti-hypertensives and statins; commonly initiated medications included laxatives and vitamin supplements. Analgesia was often adjusted. Conclusions System interventions in frailty to promote polypharmacy reviews can reduce the number of inappropriate medications. Ultimately, patient centred medication reviews will optimise polypharmacy management, reduce harm and improve patient outcomes.