Polypharmacy and potentially inappropriate medications (PIMs) are common and rapidly increasing health problems in the older adult population. Skilled nursing facility (SNF) patients are prescribed PIMs, which are linked to increased adverse drug events (ADEs) and rehospitalizations. The purpose of this quality improvement (QI) project was to implement and evaluate an evidence-based practice (EBP) deprescribing protocol focusing on reducing PIMs as defined by the American Geriatric Society (AGS) Beers Criteria (2023), using Linsky et al. (2019)’s Deprescribing Model as a conceptual framework. The protocol was implemented during 30-day follow-up visits using the ‘Plan, Do, Study, Act’ (PDSA) QI model. Two cycles were completed, each over a one-month period. Cycle 1 met the goal of reducing PIMs by at least 10% and reducing rehospitalizations by 2 percentage points (ppt) from baseline. 7 PIMs were discontinued, reducing PIMs by 12.9%, and rehospitalizations by 2.3 ppt from baseline, representing a relative decrease of approximately 34.3%. Cycle 1 results informed cycle 2 implementation. Cycle 2 met the goal of further reducing PIMs by at least another 10% (20% from baseline) and rehospitalizations by 1 ppt (3 ppt from baseline). 9 PIMs were discontinued during cycle 2 30-day visits (29.6% reduction from baseline). Rehospitalizations had a relative decrease of approximately 64.2% (4.3 ppt) from baseline. Findings from cycle 1 and cycle 2 illustrate the effectiveness of the addition of the protocol and its association with reducing PIMs and rehospitalization rates. Limitations include small sample size (45 in cycle 1, 49 in cycle 2). Future recommendations and implications for practice include a further focus on the prioritization of specific PIMs, monitoring ADEs, and noting any improvement in medication administration errors.
Sargent et al. (Thu,) studied this question.