40 Using the Variable Indication of Placement Tool to Drive De-prescribing in the Frail Older Person in an Interdisciplinary Integrated Team

Abstract

Abstract Background The variable indicator of placement (VIP) tool is designed to identify patients at risk of frailty. The risk of harm in a frail older person increases as the number of prescribed drugs increases. Polypharmacy may be either appropriate or inappropriate. Deprescribing, aims to withdraw inappropriate medication under supervision, in order to improve outcomes. Methods 50 consecutive patients, attending an emergency department, were triaged with the VIP tool, triggering a single interdisciplinary assessment (SIA) by an integrated care team member. The SIA identified polypharmacy. Drugs which may be causing harm, may no longer be of benefit or were potentially interacting with other drugs, were identified. The Anti-cholinergic Burden (ACB) Score was calculated. Appropriate medication changes were made following interdisciplinary and patient/carer discussion. Patients were selected for one to one pharmacy and patient/carer liaison, which was followed through into their community setting e.g. long term benzodiazepine usage. Results The drugs which were identified for gradual withdrawal or cessation were benzodiazepines (n=6), opiates (n=4), genitourinary (n=2), digoxin (n=2), hyoscine (n=2), domperidone (n=2) and amitryptilline (n=1). The total ACB score for 50 patients was 95 pre-assessment and 65 post-assessment. This represented a 32% reduction in anti-cholinergic burden alone for this frail older adult cohort. Conclusion The VIP tool if used to trigger an SIA, can target those patients at risk of the adverse effects of polypharmacy. The calculated ACB score can trigger meaningful discussion with patients and carers around what matters to them. A system for supervised deprescribing is necessary to ensure successful reduction in ACB.