De-prescribing and STOMP
De-prescribing is synergistic with inappropriate polypharmacy to reduce potentially problematic prescribing, adverse effects and inappropriate or ineffective medicine use by regularly re-evaluating the ongoing reasons for, and effectiveness of medication therapy. This should be done in partnership with the patient (and sometimes their carer) and supervised by a healthcare professional.
There are a variety of national programmes of work on polypharmacy and de-prescribing; from prescQIPP, EDeN and the RMOCs. The local De-prescribing working group will aim to link to these networks and feed in and take from their wider agendas. A need to work collaboratively with all sectors across the ICS has been identified to ensure equity for patients. A joined up approach to changing the attitudes of patients and clinicians is essential to achieve meaningful outcomes in reducing inappropriate polypharmacy.
NHS Scotland have produced some helpful resources to aid clinicians when conducting medication reviews and considering de-prescribing
The Royal College of General Practitioners has produced a Top Ten Tips document to aid clinicians to discuss de-prescribing of dependence forming medications such as opioids, z drugs, benzodiazepines, gabapentin and pregabalin.
The Live Well With Pain website contains a wide range of resources for patients and clinicians, from patient leaflets to educational videos for prescribers. Below are links to a selection:
Supporting self management
- Key resources for clinicians to support patient engagement in self management
- Ten top tips towards self management of persistent pain video for GPs
- Pain and the brain, how it really works
- Live well with pain posters
- Live well with pain - Ten Footsteps interactive guide for patients
- Live well with pain - Ten Footsteps guide for clinicians
- The health needs assessment
- The pain toolkit
Shifting the conversation
Starting an Opioid
- Pain and pain prescribing: what is in a number? (Article)
- Chronic pain pathway ladder
- National guidance for patients and Healthcare professionals
- Opioid equivalence, risks and recommendations
- Opioid manager (considerations of opioid trial)
- Person Centred Management of Chronic Non Cancer Pain
- Opioid deprescribing guide (Notts APC guide to tapering opioids)
- Opioid tapering resource pack (full pack of step down and review materials)
- Medication review and taper form (For patients)
- Using my medicines
- Reducing opioid medicines (information leaflet)
- Opioid tapering (information leaflet)
- Risks of opioid medication (information leaflet)
Medicines and your patient
Resources for patients
- Opioid thermometer for patients
- Six questions to ask yourself
- Opioids: the downside – waiting room poster
- Sleep well with pain leaflet
- Your journey with pain
- Explaining pain - booklet
- Resources worth exploring (useful books and websites)
- Pain is like an iceberg - poster
- My live well with pain leaflet
STOMP stands for stopping over medication of people with a learning disability, autism or both with psychotropic medicines. It is a national project involving many different organisations which are helping to stop the over use of these medicines. STOMP is about helping people to stay well and have a good quality of life.
The aims of STOMP are to:
- Encourage people to have regular check-ups about their medicines
- Make sure doctors and other health professionals involve people, families and support staff in decisions about medicines
- Inform everyone about non-drug therapies and practical ways of supporting people so they are less likely to need as much medicine, if any.
More information about the national project can be found on the NHS England STOMP webpage.
Resources for Healthcare Professionals
Resources for Patients and Carers
In Nottinghamshire, there is a STOMP working group which supports the aims of the national project at a local level. Group members are from various partner organisations across the ICS including: Nottinghamshire Healthcare NHS Foundation Trust, Nottingham and Nottinghamshire CCGs and City/County Councils. Within this, there are three subgroups looking at STOMP across all settings.
Prevention - This subgroup is looking to raise awareness of STOMP/STAMP in Children's services; also considering this when developing and reviewing Education Health Care Plans (14-18 year olds).
Reduction - This subgroup is looking to increase availability of STOMP resources/support. This includes the provision of education/training on STOMP to a variety of healthcare professionals including alternatives to medication.
Monitoring - This subgroup is working on monitoring of medication as part of the Annual Physical Health Check; ensuring resources and templates for GPs are adequate.
A new central point of contact (a single point of access) has been set up to support both healthcare professionals and patients/carers across Nottinghamshire.
The contact point is open to you if you are a healthcare professional and require advice/support regarding STOMP for a specific patient. The contact point is also open to you if you are a patient with a learning disability, or support someone that does, and you want advice or to make a referral around issues related to their learning disability.
The team can be contacted on:
Tel: 0300 303 1930
9am – 5pm Monday to Friday
Or e-mail at IDDReferrals@nottshc.nhs.uk
Positive Behavioural Support (PBS)
PBS is an effective and ethical way of supporting people with learning disabilities who are at risk of behaviour that challenges. PBS is a framework for developing an understanding of behaviour that challenges rather than a single therapeutic approach, treatment or philosophy. It is based on an assessment of the broad social, physical and individual context in which the behaviour occurs, and uses this information to develop interventions. The overall goal of PBS is to improve the person’s quality of life and of those around them, thus reducing the likelihood of challenging behaviour occurring in the first place.
For more information on PBS visit the Challenging Behaviour Foundation website.