Structured Medication Reviews: The Comprehensive Guide
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Last Updated: October 2023
Structured Medication Reviews: A Crucial Component of Effective Patient Care
When it comes to patient care, ensuring the safe and effective use of medications is essential. One critical aspect of this process is conducting structured medication reviews (SMRs), which is part of the Network DES. At Core Prescribing Solutions, our core mission is to support healthcare professionals and patients in optimising medication therapy and improving overall health outcomes.
In this comprehensive guide, we explore the importance of SMRs, how they are conducted, and the benefits they offer for both patients and healthcare providers.
Table of Contents
- What are Structured Medication Reviews
- The Importance of SMRs in Patient Care
- The SMR Process: Key Steps and Considerations
- Benefits of Structured Medication Reviews
- Your Guide to Navigating Structured Medication Reviews
- Roles and Responsibilities of Healthcare Professionals in SMRs
- Final Thoughts and Key Takeaways
- Integrating SMRs with Core Prescribing Solutions Services
- Frequently Asked Questions about SMRs
- SMRs: Resources and Further Reading
What are Structured Medication Reviews?
Structured medication reviews are a systematic approach to evaluating a patient’s medication regimen, ensuring that each prescribed medication is appropriate, effective, and safe. SMRs typically involve collaboration between healthcare professionals, including pharmacists, general practitioners, practice nurses and patients.
The goal is to optimise treatment plans and improve patient outcomes by identifying and addressing any medication-related issues, such as drug interactions, side effects, or adherence problems.
The Importance of SMRs in Patient Care
Structured Medication Reviews (SMRs) are a cornerstone of effective patient care, particularly emphasised within prescription review processes in GP practices, where the role of pharmacists is crucial in ensuring safe and effective use of medications.
According to the World Health Organisation, medication errors contribute to an estimated 1 in 10 hospital admissions globally. SMRs play a vital role in reducing these errors by ensuring medication safety and efficacy, as highlighted in the NICE guidelines for medication administration, which emphasises the need for rigorous review protocols to maintain high standards of patient care, as highlighted in the nice guidance medication review. This guidance emphasises the need for rigorous review protocols to maintain high standards of patient care.
Ensuring medication safety and efficacy:
For Example: A 65-year-old patient with diabetes and hypertension is prescribed metformin and lisinopril. During a structured medication review, the clinical pharmacist discovers that the patient has impaired renal function. As a result, the clinical pharmacist recommends adjusting the metformin dosage to prevent potential complications associated with its use in patients with renal impairment. This ensures the medication is both safe and effective for the patient’s unique health situation.
Identifying and resolving drug interactions or contraindications:
Example: A patient is prescribed warfarin, an anticoagulant, for atrial fibrillation. During the SMR, the pharmacist notes that the patient is also taking simvastatin, a cholesterol-lowering medication. Because the combination of these two medications can increase the risk of bleeding, the clinical pharmacist recommends switching to an alternative statin with a lower risk of interaction, such as atorvastatin.
Monitoring patient adherence to treatment plans:
Example: A patient with asthma is prescribed an inhaled corticosteroid for daily use and a short-acting beta-agonist for emergency relief. During the SMR, the clinical pharmacist discovers that the patient has been using the short-acting beta-agonist frequently and not taking the inhaled corticosteroid regularly. The clinical pharmacist then counsels the patient on the importance of daily corticosteroid use and develops a plan to improve adherence to the prescribed regimen.
Minimising polypharmacy, particularly in elderly patients or those with multiple chronic conditions:
Example: An 80-year-old patient with hypertension, osteoarthritis, and type 2 diabetes is taking eight different medications. During the SMR, the pharmacist identifies that two medications have similar therapeutic effects, and one medication is no longer necessary due to improvements in the patient’s health condition. By streamlining the medication regimen, the pharmacist minimises polypharmacy, reducing the potential for adverse effects and improving the patient’s overall quality of life.
Reducing healthcare costs by optimising medicines use:
Example: A patient with chronic obstructive pulmonary disease (COPD) is prescribed multiple inhalers with different doses and frequencies. During the SMR, the pharmacist identifies that the patient could benefit from a combination inhaler, which would simplify the treatment plan and reduce the overall cost. By consolidating the patient’s therapy into a single inhaler, the pharmacist helps lower out-of-pocket expenses for the patient and reduces the burden on the healthcare system.
The SMR Process: A Step-by-Step Overview
The SMR, an essential part of medication review GP services, involves several steps that ensure each prescribed medication is beneficial and safe for the patient. This process includes:
Gathering comprehensive medication and patient history:
Obtain a complete and accurate list of the patient’s medications, including prescription and over-the-counter drugs, herbal supplements, and vitamins. Collect relevant information on the patient’s medical history, allergies, and lifestyle factors that may impact medication use.
Identifying potential medication-related problems or risk factors:
Assess each medication for potential issues, such as drug interactions, contraindications, duplicate therapy, or inappropriate dosing. Consider the patient’s risk factors, including age, comorbidities, and renal or hepatic function.
Assessing the appropriateness, safety, and efficacy of each medication:
Evaluate whether each medication is necessary, effective, and safe for the patient’s specific needs. Consider the potential for adverse effects, drug interactions, and the patient’s ability to adhere to the regimen.
Developing a plan to address identified issues:
Formulate recommendations to resolve medication-related problems, such as discontinuing a medication, adjusting dosages, or suggesting alternative treatments. Involve the patient in the decision-making process and ensure they understand the rationale behind any changes.
Communicating findings and recommendations to the patient and healthcare team:
Share the results of the SMR and proposed action plan with the patient and other healthcare professionals involved in the patient’s care. Collaborate with the team to implement changes and monitor patient progress.
Implementing and monitoring the revised treatment plan:
Follow up with the patient and healthcare team to assess the impact of the changes on the patient’s health outcomes, medication adherence, and overall well-being. Document any further recommendations or adjustments to the treatment plan as necessary.
Documenting the SMR process and outcomes:
Maintain accurate and up-to-date records of the SMR in the patient’s Electronic Health Records, including the medications reviewed, identified issues, recommendations, and patient outcomes. This documentation can help inform future medication reviews and provide valuable insights for ongoing patient care.
Common Challenges Faced by Healthcare Professionals:
Limited Time and Resources: One of the most common challenges faced by healthcare professionals in implementing SMRs is the lack of time. The process can be time-consuming, especially for those handling a large number of patients. Additionally, limited resources, such as insufficient staffing or funding, can also make it difficult to conduct SMRs effectively.
Inadequate Training: Healthcare professionals may lack the necessary training or expertise to carry out medication reviews. This could result in inconsistent or suboptimal results, which could potentially compromise patient safety.
Resistance to Change: Like any new process or strategy, implementing SMRs may encounter resistance from staff. This could be due to a lack of understanding of the benefits of SMRs, reluctance to change existing workflows, or skepticism about the effectiveness of the process.
Lack of Interdisciplinary Communication: Effective SMRs require collaboration and communication among various healthcare professionals. However, barriers to interdisciplinary communication can make it challenging to conduct SMRs properly.
Strategies for Overcoming Barriers and Improving SMR Implementation:
- Efficient Time Management and Resource Allocation: Prioritising SMRs and effectively managing time by allocating enough pre-booked appointments can help healthcare professionals incorporate them into their practice. Additionally, advocating for the allocation of necessary resources, such as staffing or funding, can support SMR implementation.
- Training and Education: Providing healthcare professionals with the necessary training and resources can ensure they are equipped to conduct effective SMRs. This could include workshops, seminars, or online courses on the process and importance of medication reviews.
- Promoting a Culture of Change: Encouraging a culture of continuous learning and improvement can help reduce resistance to change. This could involve clearly communicating the benefits of SMRs, acknowledging the efforts of staff, and creating a supportive environment where feedback is welcomed.
- Fostering Interdisciplinary Collaboration: Encouraging collaboration and communication among healthcare professionals can enhance the effectiveness of SMRs. Regular team meetings, shared decision-making, and using collaborative tools or platforms can help foster a team-based approach to patient care.
- Leveraging Technology: Using technology, including medication management software and Electronic Health Records (EHRs), can streamline the SMR process and make it more efficient. These tools enable precise tracking of medication history, aid in identifying potential issues, and enhance communication among the healthcare team, ultimately supporting better patient care
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The Key Benefits of Structured Medication Reviews
The Structured Medication Review process involves several key steps:
Improved patient safety and reduced medication-related harm:
Structured Medication Reviews (SMRs) play a crucial role in improving patient safety by identifying and resolving medication-related problems such as drug interactions, contraindications, and inappropriate dosing. By addressing these issues proactively, SMRs can significantly reduce the risk of adverse drug events and medication-related harm, ultimately enhancing the overall safety and quality of patient care.
Enhanced patient adherence to treatment plans:
SMRs provide an opportunity for healthcare professionals to engage with patients through a comprehensive medicine review process, ensuring that their medication regimens are safe, effective, and aligned with their health needs.”. By discussing the purpose, dosing, and administration of each medication, healthcare providers can promote patient understanding and adherence to treatment plans. Additionally, SMRs can help identify barriers to adherence, such as complex regimens or side effects, enabling healthcare professionals to devise strategies to overcome these obstacles and improve patient outcomes.
Optimised medication therapy for better health outcomes:
By systematically assessing the appropriateness, safety, and efficacy of each medication, SMRs help ensure that patients receive the most effective treatment for their specific needs. Healthcare professionals can use SMRs to optimise medication therapy by discontinuing unnecessary medications, adjusting dosages, or suggesting alternative treatments. This tailored approach to medication management can lead to better health outcomes and improved quality of life for patients.
Reduced healthcare costs associated with medication-related issues:
Medication-related issues, such as adverse drug events, hospital readmissions, and polypharmacy, contribute significantly to healthcare costs. By identifying and addressing these issues through SMRs, healthcare professionals can help reduce the financial burden on both patients and the healthcare system. Optimising medication therapy and improving patient adherence can lead to fewer hospitalisations, emergency department visits, and overall healthcare costs.
Strengthened collaboration and communication within the healthcare team:
SMRs foster collaboration and communication among healthcare professionals, including clinical pharmacists, general practitioners, nurses, and specialists. This interdisciplinary approach promotes a shared understanding of the patient’s medication regimen, medical history, and healthcare needs. By working together, the healthcare team can develop comprehensive, patient-centred treatment plans that enhance patient outcomes and overall satisfaction with care.
Increased patient satisfaction and trust in healthcare providers:
By involving patients in the SMR process and addressing their concerns, healthcare professionals can build trust and rapport with their patients. Engaging patients in the decision-making process and providing clear, concise explanations of medication-related issues and recommendations can lead to increased patient satisfaction and confidence in their healthcare providers. This positive relationship can promote better patient adherence to treatment plans, ultimately resulting in improved health outcomes and quality of life.
Your Guide to Navigating a Structured Medication Review
In healthcare, having clear information about treatments and processes is essential for patient well-being. Understanding how often are medication reviews needed depends on the patient’s health status and specific care plan. Regular reviews, typically scheduled at least annually, help ensure that medications remain safe, effective, and aligned with the patient’s ongoing health needs In this section, we’ll explain why these reviews are necessary, what should be included in a medication review, how to prepare for an appointment with a Clinical Pharmacist, and what typically happens during and after the review. By understanding these aspects, patients can make better decisions and get the most from their healthcare interactions.
Why do I Need a Review?
A medication review is essential for several reasons:
- Medication Optimisation: To ensure your medications are still necessary, effective, and safe given your current health status.
- Identify Issues: To catch and address problems like drug interactions, side effects, or adherence issues.
- Minimise Polypharmacy: Especially important for individuals with multiple medications or chronic conditions to reduce the risk of adverse effects.
- Education: To better understand your medications, their purposes, and how to manage them effectively.
- Cost Management: To possibly streamline your medications, reducing costs without compromising care.
- Improved Health Outcomes: By optimising medication management, you’re more likely to experience better health outcomes.
How can I get the most from my Appointment with my Clinical Pharmacist?
To get the most out of your appointment with a Clinical Pharmacist at Core Prescribing Solutions, follow these steps:
- Prepare a list of all medications you are currently taking, including prescription medicines, over-the-counter drugs, vitamins, and herbal supplements.
- Draft a list of questions you have about your medications, such as side effects, interactions, or the right time to take them.
- Bring along anything relevant to your medication management, like a medication diary or any devices you use (e.g., inhalers, blood glucose monitors). Your Clinical Pharmacist will appreciate having all the necessary information to provide you with comprehensive care during the Structured Medication Review.
What Happens at a Structured Medication Review?
A Structured Medication Review (SMR) is a systematic evaluation of a patient’s medication regimen by a clinical pharmacist. Here’s how it’s generally carried out:
- Preparation: Compile a comprehensive list of medications, including prescription, over-the-counter drugs, and supplements.
- Review Session: Conduct a face-to-face or virtual consultation to discuss medication usage, adherence, and any concerns.
- Evaluation: Assess each medication for necessity, efficacy, and safety considering the patient’s health status and other medications.
- Recommendations: Provide recommendations for optimising the medication regimen, which may include dosage adjustments, discontinuations, or new prescriptions.
- Communication: Share findings and recommendations with the patient and their healthcare team for coordinated care.
- Documentation: Document the SMR process and outcomes in the patient’s health records for future reference and ongoing care management.
What Happens After a Structured Medication Review?
After the Structured Medication Review (SMR), the following steps typically occur:
- Implementation: Recommendations from the SMR are implemented. This may include medication adjustments, discontinuations, or additions.
- Communication: Findings and recommendations are shared with your healthcare team to ensure coordinated care.
- Monitoring: Your Clinical Pharmacist and healthcare team will monitor the effects of any changes to your medication regimen, ensuring they are achieving the desired outcomes.
- Follow-Up: There will be follow-up appointments to assess the effectiveness of the changes and to address any further concerns or questions you may have.
- Documentation: The SMR process and outcomes are documented in your health records for future reference and ongoing care management.
This structured approach ensures that your medication regimen continues to be safe and effective, aligned with your healthcare goals.
Roles and Responsibilities of Healthcare Professionals in SMRs?
Successful SMRs require collaboration among various healthcare professionals, including clinical pharmacists, general practitioners (GPs), nurses, and specialists. Each professional plays a unique role in the process:
- Clinical Pharmacists: Can Lead and execute the SMR process, gathering medication histories, identifying potential issues, and formulating recommendations. They provide expert clinical knowledge and guidance on medication safety, efficacy, and appropriate use.
- General Practitioners: Collaborate with clinical pharmacists, provide medical history and context, review recommendations, and prescribe changes to the medication regimen as needed. They also monitor patient outcomes and maintain ongoing communication with the healthcare team.
- Nurses: Assist with patient education, support adherence to treatment plans, and communicate any observed issues or concerns to the healthcare team. Nurses play a critical role in monitoring patients and ensuring their well-being throughout the SMR process.
- Specialists: Offer expert advice on managing specific medical conditions and medications. They work closely with the primary healthcare team to ensure that the medication regimen is tailored to the patient’s unique needs and aligns with the latest clinical guidelines.
Final Thoughts and Key Takeaways
Structured medication reviews are an essential component of effective patient care, helping to ensure the safe, appropriate, and effective use of medications.
By understanding the importance of SMRs and implementing best practices in conducting these reviews, healthcare professionals can significantly improve patient outcomes, enhance collaboration within the healthcare team, and reduce healthcare costs.
At Core Prescribing Solutions, we are committed to supporting healthcare professionals and patients in optimising medication therapy through our comprehensive range of services, including SMRs to our partner Primary Care Networks (PCN’s) and GP Practices.
How to Integrate SMRs with Core Prescribing Solutions Services
At Core Prescribing Solutions, we offer a range of services designed to support healthcare professionals and patients in optimising medication therapy. By integrating SMRs into our services, we can:
- Provide expert clinical support and guidance during the SMR process
- Offer tailored training and education for healthcare professionals involved in conducting SMRs
- Collaborate with the healthcare team to monitor and evaluate the impact of SMRs on patient outcomes
- Have many teams of clinical pharmacists nationally supporting PCN’s and GP Practices in delivering SMR’s
Get in touch with us today and see how we can help.
Frequently Asked Questions about Structured Medication Reviews
2. How often should structured medication reviews be conducted?
The frequency of structured medication reviews depends on the patient's specific needs and healthcare circumstances. For patients with complex medication regimens, multiple chronic conditions, or a history of medication-related issues, more frequent reviews may be necessary. In general, it is recommended that patients with complex needs undergo an SMR at least annually, or more frequently if clinically indicated. For patients with stable, well-managed conditions, a review every 2-3 years may be sufficient. Ultimately, the decision on how often to conduct SMRs should be based on the individual patient's risk factors, healthcare needs, and the clinical judgment of the healthcare team.
3. What are the challenges and barriers to implementing SMRs in practice?
Implementing SMRs in clinical practice can face several challenges and barriers, including limited time, lack of resources, inadequate training, and resistance to change. Healthcare professionals may find it difficult to allocate sufficient time for conducting thorough medication reviews, given their existing workload and competing priorities. Limited resources, such as staffing and funding, can also constrain the ability of healthcare teams to conduct SMRs effectively. Additionally, some healthcare professionals may lack the necessary training or expertise to carry out medication reviews, leading to inconsistent or suboptimal results. Lastly, resistance to change and a lack of understanding of the benefits of SMRs may impede their adoption and integration into routine clinical practice.
4. How can technology and digital tools support the SMR process?
Technology and digital tools can greatly enhance the SMR process by streamlining various aspects of the review and promoting collaboration among healthcare professionals. Some ways in which technology can support the SMR process include:
Facilitating data collection and management: Electronic health records (EHRs), medication management software, and mobile apps can help healthcare professionals collect, store, and analyze patient information and medication histories more efficiently.
Improving communication and collaboration: Secure messaging platforms and telemedicine solutions can enable healthcare professionals to share patient information, discuss recommendations, and coordinate care more effectively.
Providing access to up-to-date clinical guidelines and drug information resources: Online databases, such as the British National Formulary (BNF) or the National Institute for Health and Care Excellence (NICE) guidelines, can help healthcare professionals make evidence-based recommendations during SMRs.
Supporting patient education and engagement: Mobile apps, online resources, and medication reminder tools can help patients better understand their medications, track adherence, and manage side effects, ultimately improving their overall healthcare experience.
SMRs: Resources and Further Reading
Here’s a list of resources that can provide more information on Structured Medication Reviews (SMRs):
National Institute for Health and Care Excellence (NICE) Guidelines: The National Institute for Health and Care Excellence (NICE) Guidelines: NICE provides evidence-based guidelines for health and social care in the UK, including guidelines related to medication management and reviews, often referred to as nice guidance medication review. www.nice.org.uk.
The British National Formulary (BNF): A crucial resource for healthcare professionals involved in prescribing, monitoring, supplying, and administering medicines. Their online portal can be accessed at bnf.nice.org.uk.
Royal Pharmaceutical Society (RPS): The RPS offers a range of resources for pharmacists, including guidance on conducting medication reviews. Visit www.rpharms.com for more information.
The Pharmaceutical Journal: This publication by the Royal Pharmaceutical Society provides a range of articles and resources related to pharmacy practice, including SMRs. Visit www.pharmaceutical-journal.com.
The General Pharmaceutical Council (GPhC): The regulator for pharmacists, pharmacy technicians, and pharmacies in Great Britain. They provide standards, guidance, and resources for pharmacy professionals. Their website is www.pharmacyregulation.org.
PrescQIPP: An NHS-funded not-for-profit organisation that supports quality, optimised prescribing for patients. They have resources on medication review best practices. Visit their site at www.prescqipp.info.
The Royal College of General Practitioners (RCGP): The professional body for general practitioners in the UK. They provide resources and guidelines for general practice, including medication management. Visit www.rcgp.org.uk.
Pharmacy Research UK (PRUK): The charity dedicated to supporting pharmacy practice research in the UK. They fund research projects and provide resources that may be useful for understanding SMRs. Visit www.pharmacyresearchuk.org.
European Medicines Agency (EMA): The EMA provides scientific guidelines on human medicines that help in the development and evaluation of medicines. Visit www.ema.europa.eu for more information.