Background Polypharmacy is a concern due to increasing adverse drug events (ADEs), drug interactions, poor concordance and increased pill burden, especially in the palliative care population who are taking other medications for symptoms control or their disease. Potentially inappropriate medications (PIMs) include those for primary prevention of disease that palliative patients may not develop within their lifespan. There is potential to deprescribe many of these PIMs in palliative care, without the need to restart them, improving quality of life. Lindsay et al have developed a guideline for deprescribing unnecessary medications in the palliative care population, which may assist in discussions around deprescribing in palliative care.
Aim The aims of this service improvement project were to quantify hospice inpatients prescribed potentially inappropriate medications and at risk of polypharmacy; review current practice with a view to consider introducing a deprescribing tool to aid doctors in discussions with patients around rationalising unnecessary medications.
Method A retrospective audit of 40 patient notes from two hospice inpatient units. An audit proforma was developed based on Lindsay et al’s deprescribing guideline, recording medications prescribed pre- and post-admission, length of stay, and PIMs prescribed. The agreed standards were for 80% of medications with limited benefit to be stopped and 80% of patients to be discharged on 7 medications or less.
Results 82.5% Patients were on at least 1 PIM pre-admission. On discharge, 77.5% patients continued on at least 1 PIM. Only 37.5% patients were discharged on 7 or fewer medications and 40% of patients were discharged on 10 or more medications. Gastric protection drugs (72.5%), antihypertensives (37.5%) and calcium supplements (30%) were the most common PIMs amongst inpatients.
Conclusion Although small-scale, these results indicate that there may be potential for deprescribing PIMs in the hospice inpatient unit.
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