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Complex Medication Review. Robert Hallworth Chair – Greater Manchester Non-Medical Prescribing Network. Oldham Primary Care Trust. The Levels of Medication Review. Level 3 – Clinical Medication Review. Level 2 – Concordance & Compliance Review.
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Complex Medication Review Robert Hallworth Chair – Greater Manchester Non-Medical Prescribing Network Oldham Primary Care Trust
The Levels of Medication Review Level 3 – Clinical Medication Review Level 2 – Concordance & Compliance Review Level 1 – Prescription Review Level 0 – Ad Hoc
Medication Review - particular risk groups identified in Older People NSF • Those on 4 or more medicines • Post-discharge from hospital • In care homes • Where medicine-related problems have been identified • Patients over 75 • Following an adverse change in health
Patient CB • Paracetamol – under dose? • Gaviscon – under dose? • Prochlorperazine – under dose? Adverse effects? • Propranolol – interaction with diltiazem? • Pholcodine – under dose? Adverse effects?
Patient CB • Clopidogrel – indication? Adverse effects? • Dilitiazem – adverse effects? • Monomax – dose timing • Bezafibrate – use with a statin? • Quinine bisulphate – indication? • Metformin – what is the intended dose?
Patient CB • Lansoprazole Fastabs – Dose. Cost effectiveness • Furosemide – indication • Nicorandil – is it needed? Adverse effects? • Terbinafine – course length • Ferrous sulphate – indication. Adverse effects.
Patient RK • BP control • Diabetes control • Weight – orlistat? • GI symptoms • Nicorandil • Lipid modification • Smoking • Asthma
Patient RK • Angina • Depression / mental health • Pain • Monitoring – BP, HbA1C, BG, U&Es, lipids, LFTs, PEFR
The NO TEARS tool Need and Indication Open questions Tests and Monitoring Evidence and Guidelines Adverse Events Risk Reduction or Prevention Simplification and Switches
Questions? Thank you Robert.Hallworth@nhs.net