Anticholinergic Burden Calculator (ACB2) (HP104)

Anticholinergic Burden Calculator (ACB2) (HP104)

Purpose:

This protocol will inform clinicians of the anticholinergic burden score that the patient has, as well as the drugs that contribute to the score.

What does it actually do?

Some medications have anticholinergic properties which contribute to memory loss, dementia, falls, urinary symptoms and even early death. Many common medications carry this anticholinergic effect and it is cumulative; the more you are on, the more the effect. This has been quantified in several scoring systems, including the Anticholinergic Cognitive Burden or ACB Scale (2008, revised in 2012), with many drugs being assigned a score of 1,2 or 3.
This protocol is run manually be the clinician. It calculates the score and seeks to support deprescribing decisions when performing medication reviews, including the more complex Structured Medication Reviews.  The evidence for harm from these medications is more pronounced in those aged 65 or more where the calculator is most useful. 

Key features

  • ACB Scale referenced in NICE NG97,
  • Accurately assesses all currently prescribed medications against updated ACB categories (2012) and calculates the score
  • Shows clinicians which medications are contributing to the total score and by how much,
  • Allows the clinician to code the ACB Scale in the notes,
  • Gives advice about the ACB Scale to encourage deprescribing,
  • No need to manually input all medications into an external calculator or cross reference with paper tables. 

What does it look like?

When launched the protocol appears with the following information:

If you click on the links to the medicines with different scores you will see:

Supporting CQC key areas

Safe
Managing risks
Medicines management
Effective
Assessing needs and delivering evidence-based treatment
Monitoring outcomes and comparing with similar services
Staff skills and knowledge
How staff, teams and services work together
Supporting people to live healthier lives
Consent to care and treatment
Caring
Involving people in decisions about their care
Responsive
Person-centred care
Taking account of the needs of different people
Timely access to care and treatment
Well-led
Leadership capacity and capability
Vision and strategy
Culture of the organisation
Governance and management
Management of risk and performance
Management of information
Learning, improvement and innovation

System Dependencies:

This protocol is dependent on accurate coded information within EMIS web, contemporaneously recording medication issues. 

System Trigger: 

Manually using F12.  See our separate article adding protocols to the Protocol Launcher (F12) if you need help with doing this.

Fitting your practice

Your team need to know that this protocol can be launched manually using F12. This may be a useful protocol to highlight after working your way through the QI standards for medication reviews.

Support information

Development Log

v6.4

Published 10/11/2022.
Updated drugs contained withing guidelines
Added the ability to be able to code the ACB to the records

Communications Log

Primary Care IT are pleased to announce an update to our manual Anticholinergic Burden Calculator.  We will be updating this across the estate over the coming weeks.  If you would like to be prioritised for updating, please submit a support ticket



    • Related Articles

    • Anticholinergic Burden Awareness alert (ACB2) (HP103)

      Purpose: This protocol will inform clinicians of the anticholinergic burden score that the patient has, as well as the drugs that contribute to the score via a protocol alert. What does it actually do? Some medications have anticholinergic properties ...

    • Lipid checking protocol (HP015)

      Lipid Checking Protocol (HP015) Overview/Purpose This Lipid Checking Protocol is a protocol for EMIS Web, which has been designed to guide users through managing cholesterol results and to understand the context of the results for the patient that it ...

    • Foundry RAG system (HP219 and HP220)

      Foundry RAG system (HP219 and HP220) Overview/Purpose These resources comprise of a protocol alert (Foundry alerts system HP219) and a protocol (Foundry consultation closer HP220). The protocol alert (HP219) shows the RAG status for the patient you ...

    • Autocorrect height tool (HP035)

      Purpose: This protocol will highlight if a very small height has been entered for a patient (in metres rather than in centimetres) which can adversely affect the calculation of BMI What does it actually do? When entering a height in EMIS there is no ...

    • Sick Day Rules (HP026)

      Sick Day Rules (HP026) Overview/Purpose This is a protocol alert which alerts the user of patients who should be given information about Sick Day Rules. The alert identifies patients on specific medications that require sick day rules guidance. It ...