Areas of good practice
- Medicines reconciliation is well embedded across audited reviews.
- Pharmacy input is consistently recorded for structured polypharmacy reviews.
Areas for improvement
- STOPP/START or equivalent appropriateness criteria were considered in only 50% of cases (target 90%).
- Renal function/dosing documentation is incomplete in 50% of included reviews, risking dose-related harm.
- Weakest area: Dose appropriateness reviewed (50%, target 95%).
- Lowest-performing location: Respiratory Ward (0% fully compliant across 1 cases).
Safety concerns
Flag for governance and clinical review
- 100% of included cases involved high-risk medicines — ensure local monitoring and escalation pathways are documented.
- 50% of included cases had high anticholinergic burden (3+) — prioritise deprescribing review where clinically appropriate.
Lead clinician interpretation
Editable narrative — appears in reports and ARCP evidence