Medication Deprescribing at End of Life in the Long-Term Care Population

Abstract

Polypharmacy, generally defined as taking five or more medications, is the leading cause of adverse drug events for older patients and affects as many as 95% of patients residing in long-term care. Nearly half of all patients nearing the end of their life takes ten or more medications per day. Deprescribing is the systematic reduction of inappropriate, unnecessary, or harmful medications by healthcare providers. Goals for deprescribing include improved patient outcomes, increased patient satisfaction, and enhanced patient safety. The purpose of this quality improvement project was to develop a systematic approach to medication reduction through deprescribing. The target population was hospice patients who reside in long-term care, as this patient population is at the highest risk for polypharmacy and adverse drug events. The project author educated the long-term care facility providers and pharmacists on the prevalence of polypharmacy and the benefits of deprescribing for this vulnerable population. Through interagency collaboration, the hospice nurse practitioner, hospice nurse, and facility pharmacist developed a system of regular medication reviews for the target patient population. This multidisciplinary team then made recommendations for deprescribing to the facility physician and nurse practitioner. The Doctor of Nursing Practice student collected data at regular intervals throughout the project implementation regarding the number of medications prescribed to each hospice patient. The outcome goal was a ten percent reduction in medications for hospice patients living in long-term care. Project outcomes showed a decrease in medications of sixteen percent from initial data collection to the end of the project.