Improving Medication Reviews using the NO TEARS Tool.pdf

The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.

Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.

To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Improving Medication Reviews using the NO TEARS Tool, can be viewed here.

For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

1. Nicole Edwards Consultant Nurse Practitioner NHS@Home
BSc RN MSc ACP QNI
The service improvement project has
successfully identified medication
concordance, risks and improved the
NHS@Home ability to review medication in
a person-centred holistic way.
The recommendation is to incorporate
the NO TEARS checklist into the
NHS@Home Comprehensive Geriatric
Assessment on SystmOne.
I will share the information and
outcomes of the project throughout the
wider organisation, highlighting the
parts that went well and the parts I
could have improved, allowing others
to learn from my experience of a
service improvement project and how
it can change practice.
The project focuses on medication review as part
of the comprehensive geriatric assessment
completed in the NHS@Home service.
NHS@Home aims to deliver hospital level care
into people’s homes offering an alternative to
admission and allows what matters most to the
person become central to the discussion .
NHS@Home needs a template embedded
into its CGA as it is an essential component
(BGS 2019), allowing a person centred;
holistic review of a person’s medication
completed with the person to deliver a gold
standard of care (Schuster et al. 2020).
Stakeholder analysis and organisational
engagement identified the NO TEARS
checklist (Lewis 2004) as the most
appropriate medication review tool.
Clinicians were selected by purposive
sampling with the inclusion criteria of
independent prescribers and completing the
comprehensive geriatric assessment
(CGA), using the checklist for eight weeks.
Most clinicians had not used the tool before. 61%
thought the tool was easy to use and showed
positive results in confidence, deprescribing and
identifying risks.
The data produced themes of safety, person-
centred care, improving health outcomes,
best/improved practice, medicines management
and patient and clinician satisfaction and
confidence. Clinicians expressed some negative
findings of the checklist being too long and
slowing them down.