GRAND ROUNDS: Subtract Before You Add: Deprescribing to Reduce Polypharmacy
February 14, 2019 @ 12:00 pm - 1:00 pm
Affiliation: Staff Physician, Eisenhower Health
Assistant Clinical Professor,
Loma Linda University School of Medicine
Palm Desert, California
- Appreciate the burden of polypharmacy, especially in elderly patients, and the association of polypharmacy with poor outcomes such as hospitalization, falls, cognitive impairment, and adverse drug reactions.
- Develop a systemic approach to deprescribing, including identifying patients who are at risk of poor outcomes from polypharmacy, recognizing potentially inappropriate medications, and creating a plan to discontinue medications safely and effectively.
- Anticipate patient barriers and resistance to deprescribing certain medications (e.g. sedative/hypnotics for sleep and narcotic analgesics for chronic pain) and prepare plans and approaches to successfully negotiate deprescribing in difficult situations.
- Become familiar with "legacy prescribing" - instances where medications are intended to be used for a short or defined period of time (e.g. PPI's, SSRI's, benzodiazepines, anti-platelet agents and anticoagulants) - and measures to avoid refilling unnecessary prescriptions.