Anticholinergic Review Audit

This project audits documentation of anticholinergic burden review: whether the current medicines list was reviewed, whether anticholinergic medicines were identified, whether burden was assessed using a locally agreed tool or method, whether indications and ongoing need were reviewed, whether adverse-effect risk and frailty, dementia, delirium and falls risk were considered, whether alternatives or deprescribing were weighed, and whether decisions, monitoring, patient discussion, communication and follow-up were recorded.

• Pharmacists, pharmacy technicians and medicines optimisation teams
• Geriatric medicine, frailty, falls, delirium and memory services
• Acute medicine, general medicine and rehabilitation teams
• GP practices, community services and care-home clinical teams
• QI leads, governance and patient safety teams

• Measure identification of anticholinergic medicines and assessment of cumulative burden
• Assess review of indication, ongoing need and adverse-effect risk
• Test documentation of deprescribing, substitution, dose reduction and monitoring decisions
• Review patient and carer discussion, shared decision-making and transfer-of-care communication
• Generate governance-ready and ARCP-ready evidence and a re-audit cycle

• Anonymous case identifier
• Inclusion / eligibility decision
• Anonymised context (age band, sex/gender recorded, care setting, review context)
• Clinical area / location and optional specialty / service
• Twenty anticholinergic review criteria (met / not met / not applicable)
• Free-text learning points and any project custom fields

• Live dashboard
• Audit report (Word)
• Executive summary (Word)
• Excel workbook
• PowerPoint presentation
• Conference poster
• ARCP evidence summary

This ready-built project is developed using the guidance, standards and authoritative sources listed below, so you can see what is being measured and why. Lazomis QI does not publish or own this guidance, and inclusion here does not imply endorsement or approval by any of these organisations.

• NICE

  NG5: Medicines optimisation(opens the original source in a new tab)

  Safe and effective use of medicines, structured medicines review, shared decision-making and transfer of medicines information.

• NICE

  NG56: Multimorbidity — clinical assessment and management(opens the original source in a new tab)

  Reviewing treatment burden and medicines of limited benefit in people with multimorbidity and frailty.

• NICE

  QS153: Multimorbidity quality standard(opens the original source in a new tab)

  Applies where structured medicines review in multimorbidity is within the local project scope.

• NICE

  NG97: Dementia — assessment, management and support(opens the original source in a new tab)

  Medicines review considerations for people living with dementia, including medicines that may worsen cognition.

• NICE

  NG123: Urinary incontinence and pelvic organ prolapse in women(opens the original source in a new tab)

  Applies where bladder anticholinergics are locally included in the audit scope.

• Scottish Government / NHS Scotland

  Polypharmacy Guidance — anticholinergic burden(opens the original source in a new tab)

  Comparator guidance on assessing and reducing anticholinergic burden during structured medication review, where locally acceptable.

• British Geriatrics Society

  Comprehensive Geriatric Assessment and medicines optimisation resources(opens the original source in a new tab)

  Medication history, review and anticholinergic burden resources for older people, where locally used.

• Local policy

  Local anticholinergic burden, polypharmacy, deprescribing and medicines review policies

  Local burden tool or method, score thresholds, structured medication review SOP, frailty and falls medicines review guidance, delirium and dementia policies, continence prescribing guidance, care-home medicines review SOP, deprescribing and formulary policy, pharmacy referral criteria, repeat-prescribing review policy and discharge medicines communication standard define what is required locally. Confirm local policy before setting targets.

• Designed to use anonymised or pseudonymised audit identifiers.
• This tool supports, but does not replace, clinical judgement.
• Local policy, formulary and specialist advice should be followed.
• Organisations remain responsible for local governance arrangements.
• This tool supports documentation review only. It does not recommend stopping, starting, substituting or tapering any medicine, and does not replace clinical judgement, pharmacy advice or specialist input.
• Anticholinergic burden tools, score thresholds, deprescribing rules, tapering schedules and review intervals are locally configured and are not presented here as national standards.
• Use anonymous case identifiers only — never patient-identifiable information, and never identifiable detail about prescribers, carers or family members.

Supporting guidance from the Lazomis QI Resource Library. Authoritative clinical standards referenced by this project remain separate.

• Quality ImprovementAvoiding Common PDSA Pitfalls: A Guide for Effective QIThis guide addresses frequent errors in planning, doing, studying, and acting (PDSA) cycles, offering practical advice to enhance the effectiveness of your Quality Improvement initiatives within the NHS.
• Quality ImprovementPDSA Cycles: A Practical Guide to Testing Change in HealthcareThis guide provides a practical overview of Plan-Do-Study-Act (PDSA) cycles, a fundamental tool for testing changes in healthcare quality improvement. It details how to apply PDSA effectively, common challenges, and integration with broader QI efforts.
• Templates and ToolkitsPDSA Cycle Toolkit: A Practical Guide for UK Healthcare ImprovementThis toolkit provides a practical guide and template for implementing PDSA cycles, a core methodology for continuous quality improvement in UK healthcare.
• Quality ImprovementDocumenting PDSA Cycles for Effective Quality ImprovementThis guide provides practical advice on documenting Plan-Do-Study-Act (PDSA) cycles, a crucial component of effective quality improvement in the NHS, ensuring learning is captured and shared.