Structured Medication review : Extranet

Structured Medication reviews

A structured medication review is a critical examination of a person’s medicines with the objective
of reaching an agreement with the person about treatment, optimising the impact of medicines,
minimising the number of medication‑related problems and reducing waste.

Key components of a SMR
NHS England Structured medication reviews and medicines optimisation webpage
• Shared decision-making principles should underpin the conversation
• Personalised approach – tailored to the patient
• Safety – consider the balance of benefit and risk of current treatment and starting new medicines
• Effectiveness – all prescribed medication must be effective for the patient

Identify patients suitable for an SMR
PCNs should use appropriate tools to identify and prioritise patients who would benefit from
a SMR, which is expected to include those people where there is evidence of benefit such as
those:
• in care homes;
• with learning disabilities;
• with complex and problematic polypharmacy, specifically those on 10 or more
medications;
• on medicines commonly associated with medication errors and risk of harm;
• with severe frailty who are particularly isolated or housebound or who have had recent
hospital admissions and/or falls;
• using one or more potentially addictive medications from the following groups: opioids;
gabapentinoids; benzodiazepines; and Z-drugs

PCNs should consider NICE guidelines NG5 and the Royal Pharmaceutical Society’s
polypharmacy guidance, as well as the findings of the National Overprescribing Review, in
identifying patients and determining their approach.

Once patients have been identified, PCNs should create a process for developing SMR
caseloads so that those patients in greatest need of a SMR are seen in a timely manner.

The Seven Steps Review Process should be adopted when undertaking an SMR: 7 Steps | Right Decisions

Key details of the SMR must be recorded in the patient’s clinical record. These include, but
are not limited to:

Any patient outcomes relating to changes made at the previous SMR (for repeat
SMRs)
Any express wishes/preferences communicated by the patient regarding their
medicine treatment.
For each current medicine – whether the option to stop or change was discussed
with the patient.
Whether any new medicines were discussed with the patient.
Actual changes made to the patient’s medicine therapy, the clinical rationale for the
changes & confirmation that the patient has agreed to these.
Details of any follow up required to assess the impact of any changes made.
Indication of when the next SMR should be undertaken (as opposed to routine
follow up)
Any point of non-agreement between patient & healthcare professional regarding
their medicines