Polypharmacy and Medication Reviews: A Practical Guide for Care Teams
A medicines concern rarely arrives as a neat clinical question. It may be a resident who is falling more often, someone who says their tablets are becoming difficult to manage, or a discharge that has left the care team unsure what is actually being taken.
For care assistants, healthcare assistants, nurses and managers, the practical task is not to decide alone which medicine should be stopped. It is to notice concerns, support an accurate picture of medicine use, listen to what matters to the person, and make sure the right clinician receives clear information.
Polypharmacy means a person is using multiple medicines. It should not be judged by medicine numbers alone. A person-centred medication review considers whether each medicine still offers worthwhile benefit for that individual, alongside possible harms, alternatives, personal goals, function, frailty and life expectancy.
Safety note: Do not stop, reduce or change prescribed medicines without an agreed plan with the relevant prescriber or pharmacist. Some medicines need gradual withdrawal or specific monitoring.
Why polypharmacy needs a person-centred approach
People living with multimorbidity can experience a substantial treatment burden: several medicines, multiple appointments and the practical work of managing ongoing care. NICE guidance on multimorbidity aims to optimise care and improve quality of life through shared decisions about treatment, health priorities, lifestyle and goals.
That changes the question from “How many medicines is this person taking?” to “Are these medicines and the overall plan still right for this person?”
A medicine may have a clear purpose, yet be difficult to take as intended or no longer align with the person’s current priorities. Conversely, a longer list of medicines is not automatically inappropriate. The review needs context.
What is a structured medication review?
A structured medication review (SMR) is a comprehensive, person-centred review of medicines, carried out through conversation and shared decision-making. NHS Specialist Pharmacy Service (SPS) describes it as a NICE-approved intervention intended to optimise medicines use and improve patient outcomes.
A useful review is more than checking a list. It establishes what the person is actually taking, explores their experience and goals, then agrees and communicates a plan.
Who may need prioritising for review?
SPS advises primary care networks to prioritise structured medication reviews for people including:
- care-home residents
- people with learning disabilities
- people with complex or problematic polypharmacy, particularly those taking 10 or more medicines
- people taking medicines associated with medicine errors or harm
- people who are severely frail, isolated or housebound, or who have had recent admissions or falls
- people taking potentially addictive medicines, including opioids, gabapentinoids, benzodiazepines and Z-drugs.
This is a prioritisation approach, not a reason to assume that a medicine is unsuitable. It helps teams identify people who may benefit most from a careful, timely conversation.
The seven steps of a person-centred medication review
SPS sets out a seven-step framework. It gives care teams a clear way to understand what a thorough review should cover.
1. Assess the person and their medicines
Start with a full picture: medical, social and medication history; what is prescribed; and what the person is actually using and how they use it.
In day-to-day care, useful observations might include medicines being declined, difficulty swallowing, uncertainty about timings, changes after discharge, or a person saying that a treatment is affecting their routine. Record facts clearly and follow local escalation processes.
2. Agree goals that matter to the person
The person’s priorities should shape the review. These may relate to function, independence, day-to-day routines or the balance between treatment burden and perceived benefit.
Where appropriate, involve family members or advocates in line with the person’s wishes and local arrangements. The aim is not simply adherence to a list; it is a plan developed with the person.
3. Identify medicines that may be inappropriate
Each medicine should be considered against the best available evidence. SPS notes that evidence-based tools, including STOPP/START and STOPPFrail, can support identification of potentially inappropriate medicines.
These tools support professional assessment; they do not replace an individualised decision. A medicine that appears on a screening tool may still be appropriate in a particular person’s circumstances.
4. Weigh individual benefits and risks
For every medicine, the prescriber or pharmacist should consider actual and potential benefit, possible harm, and medicine and non-medicine alternatives. The discussion should take account of clinical needs, co-morbidities, social circumstances, preferences, ability to adhere and life expectancy.
Care staff contribute valuable practical evidence here. For example, an accurate account of what happens during administration, what the person reports, and any observed change in everyday functioning can make the clinical conversation more meaningful.
5. Agree actions and a safe plan
An agreed review may lead to a medicine being continued, reduced, stopped or started. Where deprescribing is agreed, SPS advises using credible withdrawal or tapering algorithms or deprescribing guidance.
The key word is agreed. Changes need a rationale, an implementation plan and appropriate professional oversight.
6. Communicate with everyone who needs to know
Recommendations, reasons for decisions, agreed actions and monitoring plans should be documented and communicated to relevant professionals and to the person where appropriate.
For care settings, this helps reduce avoidable confusion between prescribers, pharmacies, nursing teams, care staff, the person and those close to them.
7. Monitor, review and adjust
A medication review is not complete when the conversation ends. The plan should state who will implement actions, who will monitor, and when follow-up will happen. Regular review allows the plan to be adjusted when circumstances or priorities change.
How care teams can support a safe review
Care assistants and HCAs do not need to make prescribing decisions to make a meaningful contribution. Their close knowledge of the person’s routine can help ensure that the review reflects real life rather than a medicines list alone.
Before the review
Prepare information that is factual, current and useful:
- gather all medicines the person uses, where appropriate
- note what is being taken in practice and how it is taken
- identify questions, worries or goals the person wants to raise
- record relevant observations, such as recent falls, reported side effects, difficulties managing medicines or a recent admission
- check that the right prescriber, pharmacist or relevant clinician receives the information through local processes.
During the review
Help the person participate. Encourage clear questions such as:
- What is this medicine for?
- What benefit should I expect from it?
- What possible harms or problems should we discuss?
- Are there medicine or non-medicine alternatives?
- If anything changes, what will be monitored, by whom and when?
After the review
Make sure the agreed plan is understood by the people responsible for care. Document and communicate changes, the reason for them and the monitoring arrangement in line with local policy. If the plan is unclear, seek clarification from the responsible clinician or pharmacist rather than making assumptions.
A practical polypharmacy checklist for care settings
Use this checklist to support preparation and follow-up; it is not a substitute for clinical review.
- Do we have an accurate account of the medicines the person is actually using and how they use them?
- Has the person had an opportunity to explain what matters to them and raise concerns?
- Are there observed difficulties, such as managing medicines, recent falls or a recent admission, that should be shared?
- Has a relevant prescriber or pharmacist been asked to review concerns through the appropriate route?
- Are any agreed changes, reasons and monitoring arrangements documented clearly?
- Is it clear who is responsible for implementing and monitoring the plan, and when it will be reviewed?
Common pitfalls to avoid
Treating a medicine count as the whole assessment
A high medicine count can indicate complexity, but it does not by itself determine whether treatment is appropriate. Focus on the person’s goals, actual medicine use, benefits, risks and circumstances.
Assuming the prescribed list shows what is happening
A review should reconcile the medicines being used in practice, including how they are taken. A discrepancy should be clarified through the appropriate clinical route.
Making or acting on an informal change
Stopping or reducing medicine without an agreed plan can be unsafe, particularly where withdrawal or monitoring is needed. Escalate concerns and obtain professional advice.
Leaving follow-up vague
An action without a named responsibility or review point is easy to lose. Clear communication and a monitoring plan are part of safe medicines support.
Reporting suspected adverse events
NICE states that problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the MHRA through the Yellow Card Scheme.
Reporting is not a replacement for urgent care. For severe or immediate symptoms, seek urgent clinical help rather than relying on a report alone.
Frequently asked questions
Is polypharmacy always harmful?
No. Polypharmacy describes the use of multiple medicines; it does not automatically mean the medicines are inappropriate. A person-centred review considers the purpose, likely benefit, risks, alternatives and the person’s own circumstances.
When should someone ask for a medication review?
A review may be particularly helpful when medicines are difficult to manage, there are concerns about side effects or falls, there has been a recent hospital admission, the person is frail, or they are taking many medicines. A GP, pharmacist or other prescriber can be asked about a structured medication review.
Can care staff ask questions about a medicine plan?
Yes. Care staff can raise factual observations and seek clarification through local procedures. They should not independently stop, reduce or alter prescribed medicines.
What does deprescribing mean?
Deprescribing is an agreed process of stopping or reducing a medicine when this is appropriate for the individual. SPS advises use of credible withdrawal or tapering guidance where deprescribing is agreed.
Conclusion
Good polypharmacy practice is not about reducing medicines for its own sake. It is about making sure treatment remains proportionate, understandable and aligned with the person’s health priorities and daily life.
For care teams, the most valuable contributions are careful observation, accurate information, respectful conversations and reliable follow-through. When a structured medication review is needed, those practical details help prescribers and pharmacists make safer, more person-centred decisions.
Clarivive MedInsight encourages teams to use this topic in supervision, handovers and professional development conversations. A shared understanding of medicines support helps staff recognise concerns early and communicate them clearly.
