References
Polypharmacy and deprescribing in people with learning disabilities

Abstract
Practice nurses are in place to aid in deprescibing if appropriate for the patient. Danielle Adams explores this process when treating and managing patients who are living with learning disabilities as they have specific health needs
In order to effectively manage problematic polypharmacy and stop medicines safely, it is imperative that there is an appreciation of all the factors that are involved in the deprescribing process. A collaborative, patient-centred approach is required to optimise medicines effectively and reduce inappropriate prescribing. Patients should be equal stakeholders in this process. Implementing shared decision-making, while considering the issues of capacity and consent, may contribute to improved patient empowerment and outcomes. Reflecting on the risks of deprescribing — such as the implications of relapse, and the reduction of beneficial side effects and the risk of medication errors — can provide a framework for positive patient outcomes. Key to managing these risks is effective communication between all stakeholders. The STOMP campaign is addressing the overprescribing of psychotropic medicines in people with learning disabilities. It is hoped that by reducing these medicines, in the absence of a mental health diagnosis, existing health inequalities, morbidity and premature mortality may be reduced.
The four principles of medicines optimisation (Table 1) aim to help patients get the most out of their medicines by improving outcomes, avoiding unnecessary medicines, reducing wastage and improving patient safety. (National Institute for Health and Care Excellence, 2015; NHS England, 2019a; Royal Pharmaceutical Society, 2019).
Polypharmacy occurs when a person is taking multiple medicines. It may have both positive (appropriate) or negative (problematic) effects; however, evidence suggests that polypharmacy may increase the risks of adverse effects, drug interactions, poor adherence and reduced patient outcomes (Duerden et al, 2013).
Shared decision-making, a key component of universal personalised care in The NHS Long Term Plan (NHS, 2019), aims to provide people with the same choice and control over their mental and physical health as they would expect in other aspects of their life (NHS England, 2019b).
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