(P30) A Fellow-Led Quality Improvement Initiative for Standardized Deprescribing in LTC

Objective/Aim: We will evaluate the burden of polypharmacy in long-term care residents, and we anticipate offering valuable recommendations on deprescribing medications for long-term care residents by utilizing a standardized STOPP/START criteria.

Background: Older adults residing in long-term care facilities (LTC) are prone to polypharmacy. Baseline multimorbidity, new pharmacological treatments, and ongoing use of preventative medications all contribute to long medication lists. Polypharmacy is generally defined as the use of five or more prescribed or over-the-counter drug therapies. Consequences of polypharmacy can include adverse drug effects, medication non-adherence, increased mortality, higher healthcare cost, and functional impairment. Prior studies have shown that identifying potential barriers to deprescribing and utilizing a standardized tool or framework may help facilitate the deprescribing process. We hypothesize that providing a specific tool or framework and a standardized approach will assist providers in the deprescribing process in LTC.

Quality Improvement

Methods: We applied for IRB exemption for QI projects. We reviewed charts and recorded current medication lists for the LTC residents as of October 2022 in two LTC facilities staffed by the Atrium Health Wake Forest University Geriatrics faculty. We categorized baseline medications by class and scheduled vs PRN administration. For quality improvement we will analyze each patient’s medication list using standardized STOPP/START criteria, and we will generate recommendations for the providers regarding deprescribing and reducing polypharmacy for each patient. Medication lists will be compared from baseline to the standardized deprescribing recommendations. We will conduct analysis with t-tests reporting pre/post intervention results. We provided descriptive statistics of baseline medications for our study population, and 2-tailed t-tests were used to describe differences in prescribing patterns between nursing facilities.

Results: We collected baseline data on 32 LTC patients, with median age 86 years IQR (79, 92), female n=19 (60 %), and 17 patients (53%) were in a facility staffed with geriatrics fellows. We reported median medications for all the LTC patients, with 9.5 total medications IQR (6, 13.25), 7.5 scheduled medications IQR (5, 11), and 2 PRN medications IQR (1, 3). We found an increased number of scheduled and total medications per patient in the nursing facility without geriatric fellows (p=0.011 and p=0.045, respectively).

Conclusions: We anticipate offering valuable recommendations on deprescribing scheduled medications for Long-term Care residents following implementation of our QI deprescribing protocol. There may be more medications recommendations for the Long-term Care facility providers where fellows are not routinely seeing patients. This may reflect the impact of academic teaching on patient care and prescribing practices.