Designing and pilot testing an anticholinergic medication index clinical decision support system (ACMICS) for use in hospitals to support safer prescribing for older people at risk of medication-related harm.
Background
Anticholinergic medicines are commonly prescribed to older adults for a range of conditions, but they can cause harmful side effects, including delirium, falls, physical decline and loss of independence. Risks increase when multiple anticholinergic medicines are prescribed together, creating what is known as anticholinergic burden. Around 20% of older adults are prescribed these medicines, and the burden is particularly high among people with frailty and multiple long-term conditions. Although electronic clinical decision support systems can help improve prescribing decisions, existing anticholinergic burden tools are not well integrated into hospital electronic patient records and have limited ability to predict adverse outcomes.
Researchers have previously developed an Anticholinergic Medication Index (ACMI) using linked health data from approximately 70,000 patients in the Connected Bradford dataset. The next step is to translate this into a hospital-based clinical decision support system that can automatically identify patients at risk and support safer prescribing.
Aims and Objectives
The aim of ACMICS is to design and test a hospital-based Anticholinergic Medication Index Clinical Decision Support System (ACMICS) that supports safer prescribing for older people at risk of medication-related harm.
The objectives are to:
- Develop and integrate ACMICS into hospital electronic patient record (EPR) systems.
- Automatically identify older inpatients at high risk of harm from anticholinergic medicines.
- Support healthcare professionals to undertake targeted medication reviews and safer prescribing decisions.
- Develop a training package to support implementation in secondary care.
- Produce technical guidance and implementation resources that can support future adoption across NHS organisations.
Methods
The project is being delivered through two workstreams.
- Workstream 1: Design and Integration– Researchers will conduct observations of clinical practice and work closely with patient and public contributors, healthcare professionals and software developers to design ACMICS. The system will then be integrated into hospital electronic patient record systems and a training package adapted for use in secondary care. A technical specification document will also be developed to support implementation in other hospital systems.
- Workstream 2: Feasibility Testing – Researchers will conduct interviews with healthcare professionals and patients to assess the feasibility and acceptability of ACMICS in routine hospital care. Routine clinical data, including falls, delirium, mortality, medication changes and hospital readmissions, will be used to assess implementation feasibility and inform future evaluation studies. Findings will help refine both the system and associated training materials
Further Information
The study is funded through the NIHR Research for Patient Benefit (RfPB) programme and runs from May 2025 to April 2027.
Expected outputs include:
- ACMICS, a feasibility-tested clinical decision support system for hospital settings.
- A technical specification to support implementation in other hospital EPR systems.
- A training package for healthcare professionals.
- A Good Practice Guide outlining how ACMICS can be embedded within routine clinical workflows.
- A future funding application to undertake a larger evaluation of clinical and cost-effectiveness.
If successfully implemented, ACMICS could help healthcare professionals identify older patients at risk of medication-related harm more efficiently, support safer prescribing decisions and contribute to reducing adverse outcomes such as delirium and falls among hospitalised older adults.
