Table 2 Key themes and actionable steps for deprescribing in long-term care
Themes | Examples | Actionable Steps |
|---|---|---|
Trust among team members | Recommendation from trusted physicians are critical for residents and caregivers | 1. Share deprescribing data with frontline staff 2. Tell deprescribing stories to staff, residents, and caregivers |
Previous experiences (deprescribing without adverse effects or failing to deprescribe with adverse effects) are powerful | ||
Frontline staff and proxies inform prescribers of condition changes | ||
Proxy and staff express concerns regarding medications to team members | ||
Motivating factors leading to deprescribing acceptance | Explicit and tacit understanding of risk of ADRs/side effects in the LTC population | 3. Provide geriatric-pharmacology education to frontline LTC staff 4. Align medication risk/benefit discussions with what matters most to the resident |
ADR may be the cause of a condition change or fall | ||
The desire to maintain independence | ||
Processes that support deprescribing | Care plan meeting is an opportunity to discuss medications and medication-related concerns | 5. Standardize deprescribing monitoring protocols 6. Standardize interprofessional team huddles and care plan meetings to include deprescribing conversations 7. Explicitly build deprescribing opportunities into the existing workflow at points of transitions and during falls assessments using scripts or templates 8. Strengthen non-pharmacologic treatment programs |
Nursing and proxy reports to nurse practitioners and physicians result in deprescribing | ||
Availability of non-pharmacologic alternatives can support deprescribing | ||
Falls must be reported to physicians and nurse practitioners, and this may trigger an interprofessional medication review |