Transfer of care

Moving between care settings has been shown to result in polypharmacy. For example, a patient may transfer between hospital, general practice and a care home with new medicines being added at each stage. Patients are discharged from hospital with an average of one and a half more medicines than they were admitted with.

When patients transfer between different care providers there is a greater risk of poor communication and between 30 and 70 per cent have an error or unintentional change in their medicines.

Reflex prescribing

Polypharmacy appears to occur commonly because of reflex prescribing – also referred to as a prescribing cascade. This occurs when an adverse drug reaction is misinterpreted as a new medical condition. New medicines are started in order to manage the unrecognised side effects of an existing medicine and the patient is put at risk of developing additional adverse effects relating to this potentially unnecessary treatment. A patient may end up in a situation where a prescribing vortex has occurred, in which each medicine causes a side effect that is treated by the next.