Polypharmacy And Deprescribing Discussion
APA7, cite, reference, 3 paragraphs, respond to bolded questions at the bottom of this page
On my instructors wedding day, her grandmother was shockingly delirious. Her aunt had been distantly keeping tabs on her but no one had seen her recently. At the wedding she was goofy, confused, subdued, and ate more chocolate candy than anyone had ever seen her eat in her life. My instructor rummaged through her purse and realized she was taking Benadryl 25mg TID, and had been for months. Her doctor had prescribed this months ago PRN for some mild dermatitis she was having. Benadryl is notoriously one of big medications on the Beers List, and really should be avoided in geriatrics when possible. She misunderstood and had been diligently taking it everyday, on schedule, long after the rash was gone. After stopping this, her cognitive improvement was noticeable and quick. Things like this happen everyday, even among families with healthcare providers in them, well-meaning caregivers, financial resources, and seemingly decent healthcare literacy.
Beers List 2015: https://agsjournals.onlinelibrary.wiley.com/doi/pdf/10.1111/jgs.13702 (Links to an external site.)
For those of you practicing as RNs now or recently, I’m sure many of you have been saddled with the painstaking task of medication reconciliation. As a bedside nurse, I can empathize with how mundane and frustrating this is- and how many patients and their families can’t properly participate in it.
As future prescribers and leaders however, the task of appropriate medication management gets especially complex. I’ve attached a recent NY Times article that highlights one particular family’s experience with poly pharmacy, and walks you through the difficult but necessary task of de-prescribing. While as students, we are often very focused on learning how to properly start someone on the right medication and dose, we too often forget than withdrawing and eliminating medications is equally essential. In many cases they may do more harm than good.
https://www.nytimes.com/2021/06/07/health/elderly-drugs-deprescribing.html (Links to an external site.)
Recently, the Society for Post Acute and Long Term Care (AMDA) started a Drive2Deprescribe Campaign with the goal of 25% reduction in medications in the long term care setting. I know many of you are not planning to work in this setting, however the goal of shrewdly analyzing the current medical necessity for every medication a patient is on, remains pertinent to all of us. This is especially challenging given the often short visits we’re allotted with each patient regardless of practice settings.
– For all tracks, can you think of a time in your professional past or current clinical environment where you have caught a medication concern like poly pharmacy during a med rec?
– While poly pharmacy is often associated with geriatric medicine, for non adult providers can you think of other cases within your populations where medication management would benefit from de-prescribing? Things that come to mind are acute care providers writing for codeine cough syrup for acute respiratory infections, albuterol inhalers for acute respiratory issues that then turn into chronic PRN medications for the child without an RAD or asthma dx, ADHD medication causing insomnia and then requiring sedating sleep medications, among many others.
-As future prescribers and leaders what can you do as individuals to improve the consequences of polypharmacy for your patients and institutions?
-Would you feel comfortable deprescibing a medication that you know is causing adverse symptoms without any perceivable benefit that another provider has written for? How would you navigate this?
-Has anyone worked with or in a system that seems to handle medication reconciliation/polypharmacy really well? Or especially poorly?
-Any other thoughts or insights after reading the article about Ms. Harrison?
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