Reducing Medication Use in Hospice Patients Residing in Long-Term Care

Abstract

Polypharmacy has been identified as a significant issue in the elderly that leads to an increased risk of adverse drug events resulting in increased emergency room visits and falls, leading to rising costs to the healthcare system. Polypharmacy, although poorly defined, is too many medications or unnecessary medications, which can be considered a risk and potential burden to patients and caregivers. The purpose of this quality improvement project was to educate and empower long-term care (LTC) facility and hospice nurses to recognize polypharmacy and utilize the MedStopper® online tool for recommending medications for deprescribing. Education was provided to the nursing staff regarding the recognition of polypharmacy and how to use the MedStopper® online tool to facilitate medication conversations with the patient, the family, and the provider. The MedStopper® online tool was printed for each patient weekly and reviewed with nursing staff in preparation to recommend medications for deprescribing. Medication reviews were then conducted each week to evaluate the progression of the project. Project progress, written educational articles, and photos were posted at each LTC nursing station during weekly rounding by the primary project manager. At the end of the project, the data revealed a decrease in at least one of the seven targeted drug categories for each patient, vitamin/supplements, gastrointestinal reflux, statins, anticoagulants, cognitive enhancing, antihypertensives, and antihyperglycemics. Nurses are crucial to assisting the prescriber in making excellent medication decisions for all patients and especially those residing in long-term care facilities. Nurses must be educated and empowered to advocate for the medication management of their patients. Collaboration with team members and providers can and should be guided with evidence-based tools such as the MedStopper® online tool.