World Journal of
Pharmaceutical and Life Sciences

DEPRESCRIBING IN NURSING HOME RESIDENTS: AN IMPLICIT ALGORITHM

Anne G.R. Visser*, Jos M.G.A. Schols, Rob Janknegt and Mathieu A.L.M. Prevoo

ABSTRACT

Background: Inappropriate medication use and its associated harm is a relevant problem among nursing home residents. An important solution for this problem may be deprescribing: the process of safe withdrawal of inappropriate medication, with the goal of managing polypharmacy as well as improving outcomes. Several explicit tools are available to identify potentially inappropriate medication, but these tools consist of closed questions and closed answers that are often not easily applicable for nursing home patients with their multimorbidity and complex care needs. Tools based on implicit criteria do fit into the individual patient centred care, but are sparse and the underlying evidence is lacking. Objective: The aim was to create an implicit patient centred, evidence-based deprescribing algorithm for nursing home residents. Methods: A systematic literature search of proposed deprescribing strategies was used to develop the deprescribing algorithm. All recommendations and their evidence were reviewed and eventually combined and supplemented in the implicit algorithm. Results: We identified 29 deprescribing strategies and organized these into five deprescribing steps: review all current medication; identify medications to be targeted for cessation, plan a deprescribing regimen; create partnership with patients and monitoring and documentation of the outcomes. The goal of this implicit algorithm is to guide safe and rational deprescribing for nursing home residents. Conclusions: The implicit algorithm presented in this article provides a good basis for implicit deprescribing, but needs further validation in the clinical setting.

[Full Text Article]   [Download Certificate]