(P36) Deprescribing Supplements in Nursing Home Residents: Decreased Polypharmacy and Cost

Objective/Aim: The objective is to determine the impact of a medication optimization program aimed at deprescribing supplements in nursing home residents. Expected outcomes include decreased pill burden, decreased cost, and decreased nursing medication administration time.

Background: Polypharmacy is a well-documented geriatric syndrome prevalent in the nursing home population, with supplements being a major contributor to pill burden with likely little clinical utility of these medications. The cost of supplements can be significant and often not covered by Medicare, leaving facilities or patients and families responsible for payment. In addition, supplements can have adverse effects and lead to increased time of medication administration for nursing staff.

Quality Improvement

Methods: Masonic Village is a 300 bed non-profit five star facility in Central Pennsylvania. A random sampling of 13 patients from our service was obtained and their medication lists were reviewed for supplements that do not have a current medical indication, were not linked to a specific diagnosis, or were no longer indicated due to adequate repletion. For supplements that required lab monitoring, recent labs were reviewed to see if the supplements were still clinically indicated. If no recent labs were available, these were obtained and subsequently reviewed. All suggested adjustments to the medication list were reviewed with the patient’s PCP, afterward, the patient’s POA was contacted to participate in shared decision making with goal of discontinuing supplements or adjusting dosages to limit the number of pills administered. The costs, categories, and number of supplements that were discontinued, in addition to estimating amount of nursing time saved in medication administration were calculated.

Results: In total over the patients reviewed, fourteen supplements were discontinued completely. In four instances Vitamin D supplements were changed from daily to monthly based on lab results. The total number of pills discontinued per month was 686, with an average number of pills discontinued per patient per month of 52. Medication cost savings per month per medication ranged from $1.99 (for Vitamin D, magnesium oxide, Vitamin B12) to $26.32 (Vitamin E) with total costs for the medications for all of the residents totaling approximately $100. However, administration cost savings were estimated at $4 per medication per med pass which totaled $3,3360 for all residents. Nursing administration times saved were estimated to be 7.7 hours per month. The most common supplements discontinued were B complexes, multivitamins and folate.

Conclusions: Through a medication optimization program aimed at deprescribing supplements, we were able to show decreased pill burden, cost and nursing administration time. While actual medication cost savings was less than expected, administration cost savings were significant. It may be expected that further monitoring of patient outcomes may show decreased adverse effects from supplements discontinued such as constipation, decreased appetite, and weight loss. Future studies may be targeted toward measuring these patient quality of life indicators.