What steps should I take to ensure safe prescribing for elderly patients with polypharmacy?

To ensure safe prescribing practices for elderly patients with polypharmacy, conduct regular multidisciplinary medication reviews at least annually or more frequently based on patient safety and health needs. These reviews should involve discussing the purpose, benefits, risks, and patient understanding of all prescribed, over-the-counter, and complementary medicines, including adherence and any difficulties with administration or side effects NICE.

Assess frailty and multimorbidity carefully as these factors increase the risk of adverse drug events and interactions; consider using validated tools such as gait speed or the PRISMA-7 questionnaire to guide clinical decisions NICE NG56.

Adopt a patient-centred approach that takes into account the individual's health priorities, treatment burden, and quality of life, aiming to reduce unnecessary medications and avoid prescribing cascades NICE NG56. Engage patients and carers in shared decision-making to improve adherence and address any self-modification of medication regimens NICE CG76.

Ensure clear, accurate, and up-to-date documentation and communication between all healthcare professionals involved in the patient's care to prevent fragmentation and errors, including recording indications, duration, monitoring requirements, and any changes promptly in the medical record NICE,NICE CG76.

Prescribe medicines in appropriate quantities (e.g., aligning with a 28-day supply cycle) and monitor 'when required' or variable dose medicines carefully to minimise risks NICE.

Provide training and support for healthcare staff involved in prescribing and administering medicines to maintain competence and awareness of safe practices, especially in care home settings NICE.

When prescribing opioids or other high-risk medicines for persistent non-cancer pain in older adults, exercise particular caution due to increased sensitivity and risk of adverse effects, balancing pain management with safety considerations Guerriero 2017.