Recognising hidden harms of multiple medicines
Strengthening safe medicine use in ACCHOs
This resource supports GPs and other clinicians working in Aboriginal Community Controlled Health Organisations (ACCHOs) to strengthen the way medicine related harms are identified and managed, using a structured approach to deprescribing, when clients are on multiple medicines.
One of the strongest predictors of medicine-related harm is the number of medicines a person takes.1,2
Polypharmacy (five or more medicines) is linked to increased risks of:3
- falls and fractures
- frailty and disability
- hospitalisation and death.
While every medicine has the potential for harm, there are some classes of medicine that confer a higher risk. These include anticholinergics, antipsychotics, diuretics, antidepressants, opioids, and NSAIDs. The risk becomes even higher when these classes of medicines are prescribed and taken together.2
Reducing the number of medicines a client takes can significantly lower the risk of harm. GPs play a vital role in supporting clients by creating space for open, culturally safe conversations about their medicines and working in partnership with pharmacists, Aboriginal and Torres Strait Islander Health Workers and Health Practitioners and other team members to reduce the hidden harms of polypharmacy and improve health outcomes for clients.
Key messages:
- Reducing the number of medicines a client takes can lower their risk of harm and improve overall wellbeing.
- Creating space for culturally safe, client-led conversations about medicines empowers better decision-making.
- Regular medication reviews and thoughtful deprescribing support safer, more effective care.
- Working in multidisciplinary teams, including pharmacists and Aboriginal and Torres Strait Islander Health Workers and Health Practitioners, strengthens medicine safety and client outcomes.
Ways to reduce medicine-related harm
Structured medication reviews and person-centred deprescribing frameworks are two powerful ways that support clinicians to deliver safer, more effective care. These approaches help identify medicines that may no longer be needed or may be causing harm, while also aligning treatment with the client’s health goals and preferences.
Incorporating regular medication reviews and a structured approach to deprescribing can reduce medicine related harm.2
Medication review
Everyone in the ACCHO team can play a role in identifying clients who may benefit from a medicines review. Whether it’s a GP, nurse, Aboriginal and/or Torres Strait Islander Health Worker or Health Practitioner, or another team member—starting the conversation is key.
To make the most of your team’s time and resources, prioritise clients who may be at higher risk of medicine-related harm for medication review. This may include those who:
Have changed their health goals (e.g. opting out of active treatment
Are residents in aged care, especially upon admission
One of the most beneficial interventions to reduce medicine-related harms is arranging a Home Medicines Review (HMR) or review within residential aged care homes with a credentialed pharmacist. These comprehensive reviews can improve medicine adherence, reduce adverse effects, lower the risk of falls, mitigate cognitive impairment, and decrease overall medicine burden.4 They offer a structured evaluation of a client’s medication regimen to enhance understanding, optimise use, and prevent medication-related problems.1
GPs can refer clients to credentialed pharmacists for an HMR. From July 1, 2027, this referral must include a current GP chronic condition management plan (GPCCMP) to meet updated eligibility requirements.5 MBS items 900, 903, 245, and 249 support these reviews.
Use client-friendly leaflets to help start the conversation and explain the benefits of an HMR. Medication reviews are more effective when Aboriginal and Torres Strait Islander Health Workers or Health Practitioners also attend, to provide cultural context, support communication, and assist with follow-up.
In areas where access to credentialed pharmacists is limited, consider:
- MedsChecks and Diabetes MedsChecks at community pharmacies—clients can self-refer for these services.
- Longer GP appointments, especially following a 715 Health Check, where medicine use is a required discussion point.
MBS Items for Case Conferencing, and Team Care Arrangements to build a team with allied health, pharmacists, specialists to build the supports for non-medicine alternatives and tapering plans
Useful to recognise and manage medicine related harms during medication review include:
- MAIA cumulative risk tool assesses the cumulative risk of adverse effects from a client’s medications, identifying hidden risks and supporting safer prescribing practices.
- The Handbook of tools for medicine management offers resources for managing client with multiple chronic conditions, including tools for medication regimen simplification, adherence assessment, and identifying inappropriate medicines.
Creating safe spaces for medicine conversations
Medicines conversations are most impactful when they are culturally secure, client-led, and grounded in trust. Every member of the care team has the opportunity to start a yarn about medicines with clients and refer them to a GP for a medicine review—these conversations are a powerful way to build connection and support clients in making informed choices.
When clients feel genuinely heard, respected, and empowered, they are more likely to share their experiences, concerns, and questions about their medicines. This might include challenges such as:
- difficulty swallowing tablets or managing packaging due to dexterity issues
- worries about the cost of medicines or access to treatments
- uncertainty or lack of information about how or when to take their medicines
- community expectations around medicine sharing
- social or cultural factors that influence how medicines are used.
By creating space for open, non-judgmental conversations, you can uncover important insights that help tailor care to each client’s unique context. These yarns are not just about medicines—they’re about understanding the whole person and walking alongside them in their health journey.
Use clinical yarning—a culturally secure, person-centred approach to communication. It is designed to strengthen connections between clinicians and Aboriginal and Torres Strait Islander clients—to create safe, respectful spaces for meaningful conversations about medicines.6,7 Learn more at the Clinical Yarning website.
Deprescribing framework
Deprescribing is a structured, collaborative, person-centred process that focuses on improving quality of life by safely reducing or stopping medicines that may no longer be needed or could be causing harm.4 It’s not just about taking away medicines—it’s about making sure each medicine continues to support the client’s health goals, values, and wellbeing.
Using a structured deprescribing framework alongside clinical yarning helps create a culturally secure space where clients feel heard, respected, and supported. This approach builds trust and leads to better engagement and outcomes.
Tip: Use clinical yarning to build relationships and trust. Once rapport is established, gently introduce the idea of reviewing and deprescribing medicines to support the client’s health and quality of life.
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1. Open-up: Build trust and gather information
- Begin with social yarning to understand the client’s story, lifestyle, and what matters most to them.
- Include all types of medicines in the conversation—prescribed, bush and over-the-counter medicines, as well as recreational drugs.
- Reassure clients that reviewing and possibly reducing medicines is a safe, supported process that can improve how they feel day-to-day.
2. Match-up: Understand what matters
- Explore the client’s health goals, values, and preferences.
- Identify which medicines are essential, which may be causing harm, and which may no longer be needed.
- Consider non-medicine options that align with the client’s lifestyle and priorities.
3. Write-up: Plan together
- Co-create a deprescribing plan that the client understands and feels confident about.
- Include tapering schedules where needed, and ensure the plan is shared with the broader care team for continuity and support.
4. Follow-up: Stay connected
- Monitor for any changes in symptoms or wellbeing.
- Involve family, community, and other health professionals to provide wraparound support.
- Offer regular check-ins to adjust the plan as needed and celebrate progress.
This tool has been adapted from MAIA Cumulative Medicines for the ACCHO sector – Link to MAIA topic. Further Reading on Deprescribing and specific deprescribing advice can be found:
Primary Healthcare Tasmania Deprescribing Resources https://www.primaryhealthtas.com.au/resources/deprescribing-resources/
NSW TAG Deprescribing tools https://www.nswtag.org.au/deprescribing-tools/
Australian Deprescribing Network https://www.australiandeprescribingnetwork.com.au/940-2/
RACGP Silver Book https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/silver-book/part-a/deprescribing
Strengthening medicines management in ACCHOs
ACCHOs are leaders in delivering culturally secure, community-driven healthcare. Strengthening medicines management through clear policies, procedures, and clinical governance builds on this strong foundation to further enhance client safety, quality of care, and health outcomes.
Access the ACCHO Medicines Management Guidelines for practical guidance to strengthen medicines management at your ACCHO.8
To support safe, consistent, and culturally responsive medicines use, ACCHOs can:
1. Embed medicines management into organisations systems
- Ensure medicine management processes are clearly documented, consistently applied, and understood by all relevant team members. This promotes shared responsibility and safer care.8
- Develop tailored procedures for high-risk medicines to reduce potential harm and support safe use in local contexts.8Â
- Embed medicines-related discussions into routine care, such as during 715 Health Checks, discharge summary reviews, and chronic disease assessments.
2. Empower the workforce
- Promote Aboriginal and Torres Strait Islander Health Workers and Health Practitioners as medicines champions, recognising their leadership in education, communication, and culturally secure care.
- Integrate pharmacists into ACCHO teams, especially in rural and remote areas, to provide clinical advice, support quality improvement, and collaborate with Aboriginal and Torres Strait Islander Health Workers and Health Practitioners and GPs.8
- Dedicate staff time and roles to medicines-related activities, such as recalling high-risk clients, conducting reviews, and supporting client education.
- Use chronic disease team meetings and case conferencing to regularly discuss clients on multiple medicines. This can be a dedicated session or a standing item in existing meetings.
3. Create a culture of continuous improvement
- Use regular audits and continuous Quality Improvement (CQI) processes to reflect on practice, celebrate strengths, and identify opportunities for improvement.
- Leverage clinical software tools to run audits, flag risks, and enhance communication across the care team.
- Review and adapt local practices to uncover and address hidden risks, such as polypharmacy, in ways that reflect community strengths and priorities.
4. Strengthen clinical governance
Embed medicines management into clinical governance structures, including:
- Local policies and procedures
- Standing agenda items at team meetings
- Development of local benchmarks for safe and appropriate treatment
Clients accessing care through ACCHOs often have complex health needs and may be taking multiple medicines.  A culturally secure, team-based approach—centred on yarning and collaboration—helps ensure care is safe, respectful, and effective. Empowering clients to take control of their medicines supports self-determination and leads to better health outcomes.
Continuous Quality Improvement (CQI) activity
Increasing Home Medicine Reviews (HMR) referrals
Other resources
Contact
For any inquiries or further information about the Medicines and Pharmacy team at: medicines@naccho.org.au.
