Welcome to this December issue of the Journal of Prescribing Practice.
Winter is very much upon us, and I know there is the usual increased pressure in many areas, with influenza and winter vomiting virus doing the rounds. This pressure to deal with acute situations can be overwhelming and takes focus away from the more day-to-day events, like reviewing medications and going over drug histories.
In the research round-up this month there is a focus on prescribing cascades. These can occur at any time and for any patient, but some populations are more at risk, particularly the elderly. It made me think about how good we are as prescribers, but also how good are we at deprescribing. We know that inappropriate polypharmacy occurs, and can be responsible for adverse effects and hospital admissions. This is especially true in the frail elderly population and can cause them to seek help at this time of year more than any other period.
I was recently reminded that NHS England has some great freely available online resources for this very issue, with ‘medicines optimisation’ being the watch words. This can be from you deciding to access the NICE NG5 guidance on medicines optimisation (NICE, 2015) or the NICE Quality Standard QS120 (2016a) around a structured medication review or to use the NICE NG56 multimorbidity guidance tools (2016b). Through the NHS England website you can also access other national and local guidance, toolkits, frameworks and networks to enhance your knowledge and skills. A frequently used tool in the elderly with regard to medication review is the STOPP-START tool. Most Trusts have their own versions of this to support prescribers conducting medication reviews, with good, clear guidance on appropriate and indicated treatments. If you haven't used it before, why not have a go? If you are using it already, why not refresh your memory with the original 2008 validation publication (Gallagher et al, 2008)?
I do hope you will have a chance to have some time off with friends, family and loved ones over the upcoming festive period, and I look forward to writing for you again in 2024.