Tuesday, November 6, Pam Howell, a pharmacist and research associate at Bruyère, presented to Ontario long-term care (LTC) leaders at the AdvantAge Ontario Region 7 meeting on the necessity of deprescribing in LTC homes.
Using an analogy from McMaster University’s Dr. Dee Mangin, Howell compared prescribing to music, explaining that listening to a single song is enjoyable, but if songs are layered on top of one another and the volume is slowly increased, the sound becomes chaotic and overwhelming. Drugs can have a similar effect, accumulating over time and producing unwanted side effects like confusion, balance problems, falls, and increased hospitalizations.
Deprescribing — the planned and supervised process of dose reduction or stopping a medication — is an essential component of medication management that tackles the problem of polypharmacy. Polypharmacy is a term used to describe complex medication regimens and is defined as more medications than needed, or for which harm outweighs benefit. Recent statistics show that 48 per cent of LTC residents in Canada are on 10 or more medications and that LTC seniors take a daily average of 9.9 drugs compared to the 6.7 taken by seniors living in the community.
The success and sustainability of changing people’s views on medications requires awareness and the involvement of a variety of stakeholders. Howell’s presentation got the audience talking about the roles patients, family, doctors, nurses, personal support workers, pharmacists, insurance companies, and policy makers can play in a resident’s medication plan. Incorporating deprescribing in regular medication reviews and considering care goals can foster resident-centred care. To help guide deprescribing decisions, the Bruyère Deprescribing Guidelines Research Team developed five evidence-based guidelines with associated algorithms, videos, and infographics to help caregivers determine whether it is appropriate to stop, reduce, or continue a specific medication class. These tools can also be used with residents and families to explore medication management beliefs, values, and preferences.
Howell spoke to the importance of keeping every stakeholder up-to-date on best prescribing practices to ensure consistency of care: “If you give people the opportunity, they will step up to the plate to make sure that their residents are safe. This input is crucial to avoid common roadblocks to deprescribing in LTC.”
Attendees shared their own experiences with medication management in LTC — reflecting on how deprescribing improved and simplified their approaches to medication management. One LTC home redesigned their medication order forms to include a mandatory section for medication goal setting. Another representative stated that their nurses would be happy to spend less time administering unnecessary medications and instead spend the time with residents.
In order to keep moving forward with deprescribing work in LTC, the Ontario Centres for Learning, Research, and Innovation in Long-Term Care at Bruyère is working with the Bruyère Deprescribing Guidelines Research Team to continue to meet with various groups to explore ideas for a deprescribing plan that can be applied to homes across the province.
Deprescribing is an essential tool for better medication management. With a thoughtful and inclusive approach, deprescribing can help in optimizing care plans and staying focused on resident’s goals for their health. Tools and resources for deprescribing are available on the Bruyère Deprescribing Guidelines Research Team’s the website.