The United Hospital Fund’s collaboration with seven New York nursing homes spurred an 8% decrease in the number of potentially harmful medications prescribed to nursing home residents.
The second annual, six-month-long test period also recorded a decline in the number of residents receiving 10 or more medications.
The results extended beyond numbers: Leaders also reported an increase in resident safety and quality of life.
“We’ve seen a decrease in falls and hospital admissions,” Maria L. Franco, chief pharmacy officer of participating community Gurwin Healthcare System, told McKnights Long-Term Care News. “Also, we see better cognition in some residents, and less gastrointestinal side effects from some medications.”
Medication overload can present a number of problems, particularly for residents transitioning from skilled nursing facilities to their homes.
“As part of [a] transitions project, we found that managing multiple medications was frequently cited by patients and families as a major issue in transitioning home,” Joan Guzik, director of quality and efficiency at UHF’s Quality Institute, told McKnight’s Long-Term News. “We decided to address it in the long-term care setting because we believed there to be substantial opportunity for improvement and it would be easier to address where there was a longer length of stay to review and deprescribe appropriately. ”
It’s estimated that 50% of long-term care residents receive nine or more medications, making the group twice as likely to experience adverse drug reactions than residents who received fewer. Because of this, the partnership came at the perfect time for some communities.
“Our pharmacists were already dedicated to the deprescribing initiative and to maintaining safe prescribing habits for our frail elderly population,” Stuart B. Almer, president and CEO of Gurwin Healthcare System, told McKnights Long-Term News. “UHF’s focus aligned perfectly with our own.”
But initial deprescription efforts, while well-intentioned, were met with some uncertainty from patients who were accustomed to their regular routines.
“At times, residents and families might be hesitant to deprescribe medications that they have been on for many years [because of] a perception that something is being taken away from them,” Guzik said. “With clear communication, most residents and their families actually wanted to be on fewer medications.”
Some of the medications targeted in the partnership included antihistamines, antidepressants, and opioids, which declined by 68%, 62% and 53%, respectively.
The start of something good
The seven communities that participated in the initiative were Eger Health Care and Rehabilitation Center, Gurwin Jewish Nursing and Rehabilitation Center, Hebrew Home at Riverdale, Jamaica Hospital Nursing Home, Mary Manning Walsh Nursing Home, The New Jewish Home, and Manhattan NYC Health + Hospitals/Gouverneur.
The providers are hoping to extend their deprescription efforts to other senior care segments.
“We’d love to augment the deprescribing initiatives to the rest of our healthcare system, including our assisted living residents, adult day care participants and home care patients,” Franco said. “A program dedicated to our discharged residents and others receiving our services within the community might lead to an increase in deprescribing outside of the inpatient setting for a greater global streamlining of medication regimens.”
Some providers may be unsure of where to begin when approaching high-risk medications reduction. Curating the right plan and resources could be the best starting point.
“It is important to educate the medical staff and provide them with deprescribing tools and resources as well as engage the multidisciplinary team, who is essential in monitoring the patient for any adverse reactions to deprescribing,” Guzik said.
