Background It is widely recognised that large numbers of patients remain on unnecessary medications after transition from a curative to palliative pathway. This is often the result of a lack of vigilance and confidence amongst healthcare professionals when rationalising medications . This can negatively impact on quality of life, through ‘pill burdens’ and side effects, and also places avoidable financial strain on the health service. An Australian group published an ‘OncPal deprescribing guideline’ to assist clinicians in identifying potentially inappropriate medications (PIMs), which was used to help reduce polypharmacy in patients discharged from our hospice .
Methods Retrospective case note review of patients with a prognosis of six months or less discharged from our inpatient unit during two 2 month periods, was performed. PIMs were identified using the OncPal guideline and then assessed for appropriateness independently by two hospice doctors. Following baseline data collection, the hospice used posters and multidisciplinary team meetings to encourage use of the OncPal guideline in an effort to raise awareness and eradicate futile medicines.
Results Baseline data (n=19) revealed that there were 61 PIMs on admission, of which 19.7% were deemed truly inappropriate by both doctors. Of these, 75% were discontinued, resulting in 0.16 truly inappropriate medications per patient on discharge. Between the 2 reviewing doctors, there was discordance over the perceived appropriateness of 19.7% of admission medications. Post-intervention data (n=9) showed 54.8% of admission PIMs were considered truly inappropriate by both doctors, of which 35.3% were ceased, resulting in 1.22 truly inappropriate PIMs on discharge. However, discordance had dropped to 6.5%.
Conclusions These results highlight the difficulties in managing medications in palliative patients. Whilst the OncPal deprescribing guideline may help healthcare professionals to identify PIMs, more interventions are needed to empower doctors to appropriately stop these medications, to the benefit of patients and the healthcare sector as a whole.