Medication Deprescribing at End of Life in the Long-Term Care Population (QI714)

Abstract

1.Describe the key concepts of polypharmacy and deprescribing.2.Discuss the impact of polypharmacy on patients residing in long-term care.3.Explain the benefits of deprescribing for hospice patients who live in long-term care. Polypharmacy, generally defined as taking five or more medications, is the leading cause of adverse drug events (ADEs) for older adults and affects as many as 95% of patients residing in long-term care (LTC). Nearly half of all patients nearing the end of life take ten or more medications per day. Deprescribing is the systematic reduction of inappropriate, unnecessary, or harmful medications by healthcare providers. Goals for deprescribing include improved patient outcomes, increased patient satisfaction, and enhanced patient safety. The purpose of this quality improvement project was to develop a systematic approach to medication reduction through deprescribing. The target population was hospice patients who reside in LTC, as this patient population is at the highest risk for polypharmacy and ADEs. The intervention included education for providers and pharmacists employed by the LTC facility on the prevalence of polypharmacy and the research supporting deprescribing for this vulnerable population. Through interagency, interdisciplinary collaboration, the hospice nurse practitioner and LTC facility pharmacist developed a system of regular medication reviews for their mutual patients. The pharmacist then made recommendations to the facility providers for deprescribing in seven targeted medication categories. Over the four-month implementation phase, the project author collected data at regular intervals on the number of medications prescribed to each hospice patient in the seven targeted categories. The project goal was a ten percent reduction in medications for hospice patients living in LTC. Outcomes data demonstrated an overall decrease of sixteen percent in the mean number of medications per patient in the target medication categories. There was a total reduction of twenty-five percent from peak mean to lowest mean. This process for deprescribing for hospice patients can be replicated in all residential settings to reduce polypharmacy and improve patient outcomes.