Polypharmacy Review Audit

This project audits whether polypharmacy is recognised, reviewed and documented through a structured, person-centred medicines optimisation process. It reviews whether people who may benefit from structured medication review are identified, whether the medicines list is reconciled, whether indication, ongoing need, high-risk medicines, monitoring, adverse effects, interactions, cumulative burden, frailty and organ function are considered, whether the person's priorities and any carer involvement are documented, whether deprescribing or continuation rationale is recorded, and whether follow-up, responsible reviewer and transfer-of-care communication are complete.

• Pharmacists, pharmacy technicians and medicines optimisation teams
• GP practice teams, care-home clinical leads and community teams
• Doctors, nurses, ACPs and PAs completing structured medication reviews
• Frailty, geriatric medicine, acute medicine, mental health and rehabilitation teams
• QI leads, governance teams, supervisors and educators

• Measure identification of people who may benefit from structured medication review
• Assess reconciliation, indication review, high-risk medicines review and monitoring
• Review shared decision-making, treatment burden and carer involvement
• Test deprescribing consideration, continuation rationale, follow-up and transfer 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, medicine burden category)
• Clinical area / location and optional specialty / service
• Twenty-two structured medication 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

  QS120: Medicines optimisation quality standard(opens the original source in a new tab)

  Structured medication review, patient involvement and shared decision-making about medicines.

• NICE

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

  Reviewing treatment burden, medicines of limited benefit and patient priorities in 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.

• NHS England

  Structured medication reviews and medicines optimisation(opens the original source in a new tab)

  Applies where primary care structured medication review implementation is within the local project scope.

• Scottish Government / NHS Scotland

  Polypharmacy Guidance — realistic prescribing(opens the original source in a new tab)

  Comparator guidance on the 7-Steps structured medication review approach, where locally acceptable.

• British Geriatrics Society

  Comprehensive Geriatric Assessment — medication history and review(opens the original source in a new tab)

  Medicines review within comprehensive geriatric assessment for older people living with frailty, where locally used.

• Local policy

  Local structured medication review, polypharmacy, deprescribing and medicines optimisation policies

  Local structured medication review policy, polypharmacy review SOP, medicines optimisation policy, repeat-prescribing review policy, care-home medication review SOP, frailty medicines guidance, deprescribing policy, high-risk medicines monitoring policy, anticholinergic burden guidance, renal dose-adjustment guidance, reconciliation policy, discharge medicines communication standard and EPR/ePMA/GP record documentation guidance define what is required locally. Confirm local policy before setting targets. Polypharmacy thresholds, STOPP/START outcomes, deprescribing rules, tapering schedules and monitoring frequencies are not set here.

• 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 and medication-review quality assurance only. It does not provide patient-specific prescribing, deprescribing, substitution, monitoring, tapering or withdrawal advice.
• Polypharmacy thresholds, high-risk medicine lists, STOPP/START outcomes, anticholinergic burden thresholds, deprescribing rules, tapering schedules, monitoring frequencies 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.

• Clinical GovernanceLeveraging Incident Themes for Quality Improvement and Patient SafetyThis guide helps NHS teams identify and analyse recurring incident themes, transforming reported safety events into practical quality improvement opportunities to enhance patient safety and system reliability.
• Patient SafetyIntegrating Patient Safety and Quality Improvement: A Practical Guide for UK CliniciansThis guide explains the foundational principles of patient safety and quality improvement (QI) within the UK healthcare context, offering practical strategies for clinicians to enhance safety and improve care delivery.
• Clinical GovernanceIntegrating Quality Improvement into Clinical Governance FrameworksThis article explores the vital relationship between Quality Improvement (QI) and Clinical Governance within the NHS, demonstrating how they are two sides of the same coin when aiming for continuous, systematic improvement in patient care.
• Patient SafetyHow to Select a Patient Safety Quality Improvement ProjectThis guide helps NHS teams identify and select patient safety quality improvement (QI) projects that are impactful, achievable, and aligned with organisational and national priorities. Learn how to move from identifying concerns to choosing a focused and measurable project.