We tackled overmedication in individuals with learning disabilities and autism by upskilling primary care pharmacists, facilitating structured medication reviews, and creating a supportive learning environment, leading to a significant reduction in psychotropic medication dosages and discontinuations, enhanced pharmacist confidence, increased community engagement, and receiving accolades at the HSJ Patient Safety Awards 2023.

Background

In a collaboration between NHS England’s Specialist Pharmacy Service and NHS Midlands and Lancashire, our Medicines Management and Optimisation team we set out to address the over medication of people with a learning disability, autism or both.

Many people with a learning disability have greater health needs than the general population. They are more likely to experience poor mental health and are more prone to chronic health problems. They are also 16 times more likely to be prescribed an antipsychotic medicine, with many not having a mental health diagnosis. This means that some of our most vulnerable patients are taking the most potent medicines. Secondary care does not have the capacity to see all these patients, but they all need a medication review.

Action

Upskilled primary care workforce: Identified learning and development needs to upskill pharmacists working within GP practices to undertake structured medication reviews (SMRs) in patients on antipsychotic medication.

Created a learning environment: Established a nationwide community of practice on the FutureNHS STOMP and STAMP platform (Stopping Over Medication of People with a Learning Disability, Autism or Both (STOMP) and Supporting Treatment and Appropriate Medication in Paediatrics (STAMP)). Delivered seven educational webinars, produced five podcasts and clinical experts supported the chat forum.

Improved patient care: Pharmacist participants embraced the information provided and reported that the project improved their confidence, made a difference to patients and highlighted a group of patients who had not had their medicines reviewed before.

Captured results: We evaluated the results of four online surveys and four interviews with participants and incorporated them into a final report which has been published on the FutureNHS STOMP and STAMP platform.

Impact

• 56 survey respondents reported they completed 571 STOMP medicine reviews.
• 104 patients agreed to reduce the dose of their psychotropic medication, meaning side effects such as drowsiness and weight gain would be reduced.
• 42 patients agreed to have psychotropic medication stopped.
• Pharmacists’ confidence to talk to patients increased.
• Pharmacists’ confidence to undertake SMRs in patients with antipsychotic medication increased.
• Participants found the webinars and resources on FutureNHS STOMP and STAMP platform useful.
• People remain interested in the project
• FutureNHS Community of Practice folder received a significant increase in views at the start of the project in April 2022 and downloads totalled 1478 by June 2023.

The project won the HSJ Patient Safety Awards 2023 in the ‘Learning Disabilities Initiative of the Year’ category and has also been nominated as a finalist in the HSJ Awards 2023 under the ‘Innovation & Improvement in Reducing Healthcare Inequalities’ category.

Feedback

Feedback from NHS England STOMP Lead:

“NHS ML team grew a deeper understanding & passion for the work. They put heart & soul into the work believing in the values & principles required …They provided additional technical skills and expertise… This was beyond my expectations.”

Feedback from participating pharmacists:

“One patient I asked was pleased to have been invited for an SMR and was keen to look into a possible reduction or stop to medication which had been prescribed 13 years ago and no one had asked if he still needed it.”

“The best patient feedback I have had is ‘can we deal with you each time we have a query from now on?’. That made my day!”

”Very useful and feel comfortable knowing there is a community of colleagues I can reach out too if I have any questions.”

’’This is everyone’s business… it’s not just for specialists.”