Interactive Session 2: Developing and implementing deprescribing guidelines

Linked to EAHP statements:
Section 5: Patient Safety and Quality Assurance

ACPE UAN: 0475-0000-17-023-L04-P. An application based activity.

Abstract

Deprescribing is the process of tapering, stopping, discontinuing, or withdrawing drugs, with the goal of managing polypharmacy and improving outcomes. Clinicians typically attempt to taper or stop agents on the basis of clinical experience and judgment, rather than using an approach guided by evidence.

Polypharmacy and inappropriate medication use among older adults are known to contribute to adverse drug reactions, falls, cognitive impairment, noncompliance, hospitalisation and mortality. While deprescribing—the act of tapering, reducing or stopping a medication—has been shown in small studies to be feasible and relatively safe, clinicians continue to find it difficult to stop medications. Barriers include difficulty making decisions to stop medications (both from the clinician and patient perspective), worry about stopping medications started by others, limited knowledge about how to stop medications, and concern about medication withdrawal effects. In addition, clinicians feel pressured to prescribe according to clinical guidelines but recognize that such guidelines are rarely based on evidence from studies in older populations and rarely address modifying clinical targets with advancing age or care goals.

Innovative approaches are needed to address these barriers in order to limit the negative impact of polypharmacy on our older population. Such approaches should facilitate decision-making about stopping a medication and provide clear recommendations for tapering and monitoring impact to ensure safety and effectiveness of the process. To achieve this, the Ontario (Canada) Ministry of Health and Long-Term Care has supported the systematic development and testing of a series of evidence-based guidelines for deprescribing.

This 90 minute workshop will introduce pharmacists to resources and tools that facilitate deprescribing – the dose reduction or stopping of medications that may be causing harm or no longer be of benefit. These include new deprescribing guidelines as well as online resources. Participants will work in pairs and small groups using cases to develop deprescribing plans. Findings from recent work using community engagement as a strategy for implementing deprescribing initiatives will facilitate discussion about practical challenges and solutions.

Learning objectives

After the interactive session, the participant should be able to:
• describe how the concept of ‘deprescribing’ contributes to management of polypharmacy; 
• list resources and tools available to help with making deprescribing decisions;
• assist patients and prescribers with prioritizing medications for deprescribing and carrying out deprescribing safely.

Keywords: deprescription, geriatrics, development guidelines, implementation

* No conflict of interest has been declared.