Stopping over medication of people with a learning disability, autism or both (STOMP)
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.
In a collaboration between NHS England’s Specialist Pharmacy Service and NHS Midlands and Lancashire CSU, 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.
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.
- 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 from NHS England STOMP Lead:
“MLCSU 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.”
News and views
Nicola Ainscough, Head of System Delivery, MLCSU The recent communication from NHSE, referencing the letter titled ‘Addressing the…
Recorded live at the Digital Healthcare Show 2023, host Andy Downton engages in a captivating conversation with Priyantha…
How we can help health systems
Developing health systems
Acting as an independent and trusted partner within the system to facilitate working across stakeholders and integrate elements of the provider system…Learn more about Developing health systems
Workforce resilience and transformation
Supporting systems to build a sustainable and integrated workforce, transforming systems, organisations and the workforce experience to improve resilience.Learn more about Workforce resilience and transformation
Communications and engagement
Supporting ICSs with approaches to design and deliver effective communication, engagement and behavioural insights as a key enabler for system change and…Learn more about Communications and engagement
Digitally enabled transformation and IT
Digitising care and partnering with systems for the transformation of digitally enabled service delivery (and other supporting processes) across vision, planning and…Learn more about Digitally enabled transformation and IT
PHM analytics and decision support
Applying intelligence-led understanding of the health of the population to support the redesign of care and improve patient and financial outcomes across…Learn more about PHM analytics and decision support
Place and primary care transformation
Supporting providers to work together at a place and neighbourhood level to manage common resources, integrate community teams, improve health and reduce…Learn more about Place and primary care transformation
Clinical redesign and provider collaboration
Redesigning how health and care works across England - placing people at the centre of their own health and care and utilising…Learn more about Clinical redesign and provider collaboration
Personalised healthcare commissioning services
Providing end-to-end funded care services, including patients as active partners in identifying their healthcare needs and then commissioning care to meet these.…Learn more about Personalised healthcare commissioning services
Business enabling services
Delivering a wide range of support functions through transactional services, business partnering and transformation that drives efficiencies and releases value and time…Learn more about Business enabling services