A trigger is a sign that might alert you to the fact that someone has potentially problematic polypharmacy. Pharmacy teams could use these signs to identify people who would possibly benefit from a medication review. These include:

• Multiple high-risk medicines, such as medicines with anticholinergic side effects or those listed in Patient Safety First’s How to Guide for Reducing Harm from High Risk Medicines, which is available here.
• Multiple medicines affecting renal function, e.g. NSAIDs, diuretics, ACE inhibitors
• Problems raised in an NMS or an MUR
• A patient returning unusual quantities of medicines
• A patient who is receiving social care or moving into a care home
• A patient who is taking 10 or more medicines
• Potentially harmful drug interactions present on prescription – for example, amiodarone and dabigatran or a course of macrolides with colchicine or simvastatin.

These methods may help pharmacy teams identify a patient who could benefit from a review, but a key consideration should be how to engage a person in the review process. Patients might be quite happy with their medicines regimen, and there may be some apprehension or even fear at the thought of changing it. There may be doctor/patient trust issues to consider too.

Involving a patient in the decision-making process means you can understand their views and perspective on their treatment and provide any necessary reassurance about the review process.

More information

All pharmacy professionals have access to the CPPE distance learning programme Consultation skills for pharmacy practice: taking a patient-centred approach, which can be found here. The first chapter on patient-centred care will give you an overview of the key skills you will need to engage patients in a patient-centred way.