(P34) Deprescribing Initiative Fostering Enhanced Quality of Life in Post-acute

Objective/Aim: The aim is to reduce the burden of polypharmacy for post-acute residents through collaboration with our consultant pharmacy and interdisciplinary team by targeting identified drug classes. The goal is to ascertain a 50% acceptance rate of the recommendations made by the team for each drug class thus safely reducing the number of medications deemed unnecessary.

Background: Our five post-acute facilities are part of the largest public system in the United States. The post-acute setting hosts a diverse population of 1500+ residents, many of whom have multiple chronic conditions resulting in many different drug prescriptions. Polypharmacy poses many concerns for this vulnerable population including; with age sensitivity to medication increases, higher risk for drug interactions, reduced effectiveness and adverse events are seen. In addition, there is higher probability of medication errors such as missed doses, extra doses, etc. The literature of the decreased efficacy and inappropriate use of polypharmacy is well documented. By decreasing polypharmacy, research supports a reduction in falls, decreased drug interactions, less adverse events and significantly lower hospitalizations. By decreasing pharmaceutical use, an added bonus is fiscal responsibility by decreasing expenditures on medications. In an effort to always enhance the resident’s quality of life the five post-acute sites embarked on the “drive to deprescribe.”

Quality Improvement

Methods: Beginning in January of 2021, PDSA cycles and action plans were organized by the interdisciplinary team. Initially, multi-facility education via AMDA deprescribing was conducted. Next, in collaboration with our consultant pharmacy, focused drug reviews were completed monthly. The targeted drug was deprescribed based on a risk-to-benefit analysis by the interdisciplinary team. Ad-hoc huddles created opportunity to discuss progress, barriers and next steps. A deprescribing calendar was established for accountability and check-ins.

Results: As a service line, cumulative acceptance of recommendations with deprescribing the drug classes are as follows; 36% for topical/artificial tears, 60% for multi-vitamins, 72% decrease for PPI’s, 55% for hypoglycemics, 20% for statins, 35% for anticholinergic, and 76.2% for enemas.

Conclusions: Shared decision making and awareness of resident preferences are a priority for successful deprescribing. Reducing sliding scale coverage of insulin reduced the need for fingerstick monitoring and improved resident comfort. Increased deprescribing adherence was noted when presented as a holistic approach. Next steps include tracking resident’s reasons for declination of deprescribing to facilitate alternative approaches and opportunities for deprescribing to be added to the routine interdisciplinary care plan meetings. “Drive to deprescribe” is embedded in our daily operations and has become an integral component to resident safety and quality of life.