PART IV. De-prescribing in Reducing Transmission

Overview

When it comes to medication regimens, less is actually more in reducing transmission. The fewer number of medications that need to be administered, the fewer opportunities for potential disease transmission to residents and participants. This is where de-prescribing comes in.

Download a PDF of the complete “Raising Awareness of Transmission Risks” series.

What is De-prescribing?

De-prescribing is the active process of optimizing a person’s medication list to remove medications that are no longer beneficial or could be causing harm. De-prescribing is part of good prescribing – backing off when doses are too high, or stopping medications that are no longer needed.

Medication Accumulation

The number of medications that a person is prescribed can accumulate in different ways over time. On-going de-prescribing considerations should be a part of any comprehensive medication management program. Monitoring and regular evaluations help ensure that residents and participants are only taking the medications they truly need at any given time.

There are many benefits to de-prescribing both clinically and for patient wellbeing. The recent pandemic underscores one of the primary benefits–the effectiveness of de-prescribing in limiting disease transmission during medication administration.

Considerations for De-prescribing

Goals of participant care
Limiting the potential for adverse medication events
Reducing pill burden
Reducing nursing time needed for medication management
Improving participant experience
Improving clinical and financial outcomes

De-prescribing is a collaborative and progressive process with notable benefits.

How to Safely De-prescribe

1. Establish a Process

Create an interdisciplinary team to determine the who, what, why, when and how that will work best for your organization.

2. Identify Your Target Population

Those individuals with…
- A high number of medications
- Prescribed specific target medications
- Changing quality of life considerations or care goals

3. Identify Medication Focal Points

Medications with the potential to be discontinued (permanently or temporarily) or re-formulated.
- Include vitamins, supplements, herbal products or long term preventative medications
- Evaluate medications with no clear diagnosis or indication for use
- Potential utilization of long acting or combination formulations
Medications with specific or highly involved monitoring parameters.
- Blood glucose monitoring orders, heart rate or blood pressure parameters
- Frequency of laboratory monitoring orders (i.e. – INR, CBC, LFT, etc.)
- Re-alignment of medication administration times.
- Overall goal is reduction of the number of medications, number of pills to be administered and/or number of defined administrations per day.

4. Create Awareness & Collaboration

Actively involve participants, residents, caregivers, pharmacists and providers in the process.
The participant/resident and their care goals are your focal points. Explain all plans and change thoroughly to all involved parties.

5. Establish Specific Timelines and Rigorous Monitoring Protocols

While some changes can be done immediately others may require more in depth planning, titrations or a step-wise approach.
Participant/resident monitoring and follow-up are essential for safe de-prescribing.

6. Continually Evaluate Opportunities to De-prescribe

While you are starting the process now, de-prescribing should be a continuously evaluated

De-prescribing Reduces Transmission and Leads to More Positive Outcomes

Clinical Benefits

Reduced risk for adverse effects, medication interactions, falls and resulting hospitalizations
Improved participant adherence
Improved fiscal management
Fewer medication administration intersections reducing potential for transmission

Participant & Resident Benefits

Minimized exposure to and transmission of potentially harmful pathogens
Reduced medication intake and pill burden
Optimized medication regimen to support quality of life

Every opportunity to reduce transmission risk in aging adults is a good one, pandemic or not. When done right, de-prescribing can help reduce exposure and actually improve overall patient health.

This concludes Grane Rx’s 4-Part series on how to identify and mitigate transmission risks in medication administration. You can access and share this series by following the button below.