Identifying inappropriate medicines

Anticholinergic Burden (ACB) Calculator

The ACB calculator calculates the anticholinergic cognitive effect burden score and suggests alternative options with a lower burden.

Medichec

Medichec is a free app that identifies medicines with anticholinergic cognitive effects, highlighting their extent and the cumulative impact of multiple medications.

Medichec also identifies medicines that are reported to cause QTc prolongation, hyponatraemia, bleeding risk, dizziness, drowsiness, and constipation. It then ranks them according to the frequency of reported adverse effects.

Medicines and Falls

The National Falls Prevention Coordination Group’s medicines and falls guide offers guidance on medication reviews for people at risk of falls. It highlights falls risk increasing drugs (FRIDs) and medicines linked to fractures.

Medstopper tool

The Medstopper tool is a US online deprescribing tool which ranks medicines based on their potential to improve symptoms, reduce the risk of future illness and likelihood of causing harm. It also provides information about reducing and tapering or stopping medicines.

STOPPFrail tool (v2)

The STOPPFrail tool (version 2) highlights potentially inappropriate medicines in patients aged 65 years and older, living with frailty and with a limited life expectancy. It supports prescribers by offering a structure to deprescribing and can be used in all healthcare settings.

STOPP/START tool (v3)

The STOPP/START tool (version 3) provides a list of potentially inappropriate medicines in patients aged 65 years and older based on specific criteria.  It supports prescribers to identify and reduce inappropriate prescribing.

ThinkCascades tool

Prescribing cascades occur when a medicine is prescribed to manage the side effects of another medicine, typically when a side effect is misinterpreted as a new condition.

The ThinkCascades tool outlines nine clinically important prescribing cascades consistent with potentially inappropriate prescribing in older people

Deprescribing guidance and tools

Deprescribing network

Deprescribing.org’s guidance and algorithms, developed by international deprescribing networks, offer evidence-based guidelines for deprescribing across five medication categories:

• proton pump inhibitors
• antihyperglycaemics
• antipsychotics
• benzodiazepines
• anticholinesterases/memantine.

Health Improvement Scotland Right Decision Service

The Health Improvement Scotland’s Right Decision Service is Scotland’s national decision support system for health and social care. It offers digital tools to help staff and patients make quick, evidence-based decisions safely.

Health Improvement Scotland’s guidance on polypharmacy offers tools that support quality prescribing and polypharmacy in its:

• antidepressants quality prescribing guide
• respiratory quality prescribing strategy
• type 2 diabetes quality prescribing strategy.

Health Improvement Scotland’s Manage my meds tool provides information and tools to help patients and carers understand and manage their medicines and prepare for a medicines review with a healthcare professional.

NHS Wales: Polypharmacy in older people

This NHS Wales polypharmacy in older people guide supports medicines optimisation in older patients who may have inappropriate polypharmacy.

It includes practical guides for stopping specific groups of medicines, such as:

• acid suppressants
• acetylcholinesterase inhibitors and memantine for dementia
• antidepressants
• antihypertensives
• antipsychotics for non-cognitive symptoms of dementia
• bisphosphonates
• benzodiazepines and Z-drugs
• gabapentinoids for neuropathic pain
• opioids for non-cancer pain
• oral corticosteroids
• antipsychotics for non-cognitive symptoms of dementia.

PrescQIPP Improving Medicines and Polypharmacy Appropriateness Clinical Tool (IMPACT)

The PrescQIPP Improving Medicines and Polypharmacy Appropriateness Clinical Tool (IMPACT) helps identify clinical and deprescribing priorities. It provides practical recommendations for appropriately continuing or stopping medicines and highlights key issues to consider.

Conversational tools

Ask 3 Questions

The Advancing Quality Alliance Ask 3 Questions leaflet helps patients prepare for shared decision-making by considering:

• What are my choices?
• What are the pros and cons of each option for me?
• How do I get support to help me make a decision that is right for me?

BRAN

Choosing Wisely UK promotes shared decision making conversations between clinicians and patients using BRAN questions:

• What are the Benefits?
• What are the Risks?
• What are the Alternatives?
• What if I do Nothing?

It is a collaborative process to select tests, treatments and care management or support packages, based on clinical evidence and patients’ informed preferences and values.

Three-talk model

The NICE three-talk model guides shared decision-making through three steps:

• introducing choice
• describing options using patient decision support
• helping patients explore their preferences and make decisions.

Health Innovation Network resources

The Health Innovation Network has developed patient information materials in multiple community languages to help patients prepare for and understand SMR consultations.

SPS resources

Understanding polypharmacy, overprescribing and deprescribing

This SPS article on understanding polypharmacy, overprescribing and deprescribing explores the causes, consequences and tools to support pharmacy professionals in managing these concerns in practice.

A person-centred approach to polypharmacy and medication review

This SPS article on a person-centred approach to polypharmacy and medication review outlines how to identify and invite patients for a structured medication review. It also includes a practical framework to manage inappropriate polypharmacy using a person-centred approach.

Resources to support medication review

This SPS article on resources to support medication review highlights tools to identify inappropriate medicines, guide deprescribing, and empower patients via shared decision making.

 

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