PrescQIPP

Reducing Problematic Polypharmacy: A Multi-System Transformation Project

Wirral University Teaching Hospital NHS Foundation Trust

Project summary

Problematic polypharmacy increases the risk of adverse drug reactions, falls and hospital admissions and is a significant and escalating public health problem. In February 2025, Cheshire and Merseyside (C&M) Integrated Care Board (ICB) ranked among the highest nationally across several polypharmacy indicators, with Wirral (sub-ICB) specifically scoring high for:

  • proportion of over 65-year-olds prescribed ≥5 analgesics,

  • patients prescribed ≥15 medications

  • patients prescribed ≥4 medications with an unintended hypotensive effect; thus, increasing the risk of falls.

As part of C&M ICB system-wide polypharmacy transformation programme Wirral University Teaching Hospital NHS Foundation Trust (WUTH) successfully bid for funding to employ a fixed term highly specialist hospital pharmacist to focus on reducing inappropriate polypharmacy within the inpatient setting but also supporting other settings across our System. The project started in October 2025 with an added focus on falls prevention.

Enhanced medication reviews for inpatients and proactive falls medication reviews in the community, achieved statistically significant reductions (p<0.05) in paired t-test analysis in the total number of medicines prescribed, anticholinergic burden (ACB) scores, and the number of falls risk–increasing drugs (FRIDs) prescribed. A key component of this success was the integration of the pharmacist within multidisciplinary teams (MDTs), ward rounds, and establishing a referral process to increase engagement and enable proactive identification and optimisation of patients at risk.

To support primary care clinicians, polypharmacy ‘Advice and Guidance’ pilot sessions were established, led by the project pharmacist, with input from other specialists. These sessions supported primary care pharmacists across Wirral to manage complex deprescribing decisions with greater confidence.

Workforce development and cultural change have been central to the project with a range of educational initiatives being delivered to junior doctors, pharmacists, and wider pharmacy teams to raise awareness of polypharmacy risks and embed deprescribing principles into routine practice.

This project demonstrates how a co-ordinated, cross-sector approach to polypharmacy stewardship can deliver measurable clinical outcomes, strengthen workforce capability, and establish sustainable models of care. It provides a scalable framework for reducing problematic polypharmacy and minimising medicine-related harm.

When combined, the direct drug cost savings achieved so far and estimated cost avoidance demonstrate substantial economic benefit. Based on the hourly rate of a Band 8a pharmacist and an assumption of the average medication review taking one hour to complete, this equates to a potential return on investment of £28 for every £1 invested.