Respiratory : Quality prescribing strategy - a guide for improvement
To ensure outcomes from medication are optimised, and prescribing is appropriate and safe, the 7-Steps medication review process provides a clear structure for both the initiation of new and the review of existing treatments, and places an emphasis on ‘what matters to the individual’?
A polypharmacy review (following the 7-Steps approach) should ensure optimal management of respiratory and other conditions. It should include addressing aggravating lifestyle factors and consideration of the most appropriate medication at the right dose, with regular review.
The following 7-Steps are intended as a guide to structure the review process:
Step 1: Aim: What matters to the patient?
Step 2: Need: Identify essential drug therapy.
Step 3: Need: Does the patient take unnecessary drug therapy
Step 4: Effectiveness: Are therapeutic objectives being achieved?
Step 5: Safety: Is the patient at risk of ADRs or suffers actual ADRs?
Step 6: Sustainability: Is therapy cost-effective and environmentally sustainable?
Step 7: Patient-centred: Is the patient willing and able to take therapy as intended?
The 7-Steps to appropriate polypharmacy demonstrate that the review process is not in fact a linear single event, but cyclical, requiring regular repeat and review (see the figure above). The circle is centred on what matters to the individual, ensuring they are provided with the right information, tools and resources to make informed decisions about their medicines and treatment options. It should be used at both initiation and review of medicines.
This is outlined in the Scottish Government’s Polypharmacy guidance5 with accredited Polypharmacy training available on TURAS for prescribers (three points of external CPD by Royal College of Physicians, United Kingdom). The training equips healthcare professionals (including doctors, nurses and pharmacists) to undertake comprehensive person-centred medicines reviews. The training can be accessed at NHS Education for Scotland on TURAS learn. Find more information on the iSIMPATHY website.
