Stopping Inappropriate Medicines in the Outpatient Setting

Medicines are prescribed for patients, usually appropriately, in response to illness and symptoms. Many are continued for life, especially when prescribed for chronic conditions. With increasing age, some medicines, particularly those requiring adequate organ function for drug clearance, can produce more harm than benefit. Research shows that high risk prescribing increases with the number of medicines, and that patients prescribed five or fewer medicines are less likely to present to hospital with adverse events.1,2 Polypharmacy can be appropriate with increasing morbidities in older age, but regular review is needed to ensure that each medicine is still appropriate, based on clear outcomes. We have recently described our experience of reviewing, holding and stopping medicines in the rehabilitation setting using the North West London STOPIT tool.3 Here, we describe our early experience of adapting the Screening Tool for Older People’s Inappropriate Treatments (STOPIT), including specific consideration of anticholinergic burden, for use in the outpatient setting. This was a service improvement pilot to explore the practicalities and challenges of deprescribing for elderly outpatients at the Chelsea and Westminster Hospital NHS Foundation Trust (CWFT).