Jennifer Pruskowski1, Steven M Handler. 1. Department of Pharmacy, University of Pittsburgh School of Pharmacy, University of Pittsburgh Medical Center (UPMC) Palliative and Supportive Institute, Pittsburgh, Pennsylvania, USA.
Abstract
OBJECTIVE: Many residents with life-limiting illnesses are being prescribed and taking potentially inappropriate medications (PIMs) and questionably beneficial medications either near or at the end of life. These medications can contribute to adverse drug reactions, increase morbidity, and increase unnecessary burden and cost. It is crucial that the process of deprescribing be incorporated into the care of these residents. After developing a clinical pharmacist-driven deprescribing initiative in the nursing facility, the objective of this project was to reduce the number of PIMs via accepted recommendations from the clinical pharmacist to the primary team. DESIGN/SETTING/PARTICIPANTS: The Discussion to Ensure the Patient-centered, Health-focused, prognosis-Appropriate, and Rational Medication regimen (DE-PHARM) quality improvement-approved project was conducted in an urban, academic nursing facility in Pittsburgh, Pennsylvania. The pilot phase occurred between October 2015 and April 2016. To be included in this study, participants had to be a custodial resident of the nursing facility with a previously documented comfort-focused treatment plan. All medications used for the management of chronic comorbid diseases were eligible for review. RESULTS: Forty-seven residents managed by eight different primary teams met inclusion criteria. Thirty-nine recommendations for 23 residents were made by the clinical pharmacist, with an average of 0.82 and range of 0-5 recommendations per resident, respectively. Of those, only 10 (26%) were accepted, 1 (3%) was modified, 3 (7%) were rejected, and 25 (64%) had no response within the 120-day response period. Additionally, two residents died during the project, and one resident was readmitted to the hospital for a prolonged period of time. CONCLUSION: The pilot phase of the DE-PHARM project, a clinical pharmacist-driven deprescribing initiative, was designed and assessed. This project demonstrated the feasibility of such an initiative. Because of the complexity of such a process, special attention must be paid to eligible residents and medications, the need for interprofessional collaboration, and the operational process. This project is ongoing in other nursing facilities in Western Pennsylvania.
OBJECTIVE: Many residents with life-limiting illnesses are being prescribed and taking potentially inappropriate medications (PIMs) and questionably beneficial medications either near or at the end of life. These medications can contribute to adverse drug reactions, increase morbidity, and increase unnecessary burden and cost. It is crucial that the process of deprescribing be incorporated into the care of these residents. After developing a clinical pharmacist-driven deprescribing initiative in the nursing facility, the objective of this project was to reduce the number of PIMs via accepted recommendations from the clinical pharmacist to the primary team. DESIGN/SETTING/PARTICIPANTS: The Discussion to Ensure the Patient-centered, Health-focused, prognosis-Appropriate, and Rational Medication regimen (DE-PHARM) quality improvement-approved project was conducted in an urban, academic nursing facility in Pittsburgh, Pennsylvania. The pilot phase occurred between October 2015 and April 2016. To be included in this study, participants had to be a custodial resident of the nursing facility with a previously documented comfort-focused treatment plan. All medications used for the management of chronic comorbid diseases were eligible for review. RESULTS: Forty-seven residents managed by eight different primary teams met inclusion criteria. Thirty-nine recommendations for 23 residents were made by the clinical pharmacist, with an average of 0.82 and range of 0-5 recommendations per resident, respectively. Of those, only 10 (26%) were accepted, 1 (3%) was modified, 3 (7%) were rejected, and 25 (64%) had no response within the 120-day response period. Additionally, two residents died during the project, and one resident was readmitted to the hospital for a prolonged period of time. CONCLUSION: The pilot phase of the DE-PHARM project, a clinical pharmacist-driven deprescribing initiative, was designed and assessed. This project demonstrated the feasibility of such an initiative. Because of the complexity of such a process, special attention must be paid to eligible residents and medications, the need for interprofessional collaboration, and the operational process. This project is ongoing in other nursing facilities in Western Pennsylvania.
Authors: Jennifer A Pruskowski; Sydney Springer; Carolyn T Thorpe; Michele Klein-Fedyshin; Steven M Handler Journal: Drugs Aging Date: 2019-12 Impact factor: 3.923
Authors: Joanne Reeve; Michelle Maden; Ruaraidh Hill; Amadea Turk; Kamal Mahtani; Geoff Wong; Dan Lasserson; Janet Krska; Dee Mangin; Richard Byng; Emma Wallace; Ed Ranson Journal: Health Technol Assess Date: 2022-07 Impact factor: 4.106
Authors: Nydia Burgos; Freddy J K Toloza; Naykky M Singh Ospina; Juan P Brito; Ramzi G Salloum; Leslie C Hassett; Spyridoula Maraka Journal: Thyroid Date: 2020-12-29 Impact factor: 6.568
Authors: Amadea Turk; Geoffrey Wong; Kamal R Mahtani; Michelle Maden; Ruaraidh Hill; Ed Ranson; Emma Wallace; Janet Krska; Dee Mangin; Richard Byng; Daniel Lasserson; Joanne Reeve Journal: BMC Med Date: 2022-08-31 Impact factor: 11.150