3666 Improving structured medication reviews to address polypharmacy in hospitalised older adults: a two-cycle audit

Abstract Introduction Polypharmacy—commonly defined as the use of five or more medications—is highly prevalent among older adults and is associated with increased risks of adverse drug events, falls, cognitive impairment, hospital admissions, and reduced quality of life. Inappropriate polypharmacy, where medications provide limited benefit or cause harm, represents a significant patient safety concern. Structured medication reviews (SMRs), supported by validated deprescribing tools such as STOPP/START and Beers Criteria, are essential for identifying and addressing potentially inappropriate prescribing. This quality improvement project (QIP) aimed to assess and improve SMR practices in hospitalised older adults with polypharmacy. Method: A two-cycle prospective QIP was conducted on a Health Care of the Older Person (HCOP) ward at Lincoln County Hospital. Patients aged ≥65 years and prescribed ≥5 regular medications were included. Data was collected during two two-week periods from the same ward (Cycle 1: February 2025; Cycle 2: May–June 2025), with 20 patients reviewed in each cycle. Outcome measures included the prevalence of potentially inappropriate medications (PIMs, SMR completion, documentation in medical notes, and communication of medication changes to general practitioners via electronic discharge documents (EDDs). Interventions introduced between cycles included staff education sessions, e-mail reminders and visual reminders on the ward via posters. Results: In Cycle 1, 40% of patients were prescribed PIMs SMRs were conducted for 80%, with documentation also completed in 80%. In Cycle 2, 70% of patients were on PIMs however, SMRs and documentation were both completed for 100%. Medication changes were communicated to GPs via EDDs for 100% of patients in both cycles. These results demonstrate improved consistency and quality in medication review processes. Conclusion(s) Targeted, low-resource interventions significantly enhanced structured medication review practices. Embedding SMRs into routine inpatient care improves prescribing safety and optimises outcomes for older adults.