Aims: Sedatives and anticholinergics are potentially inappropriate medicines (PIMs) associated with increased falls and decreased function and cognition in older patients. Pharmacists can partner with hospital doctors to identify PIMs, formulate deprescribing plans, and communicate medication changes across transitions of care. We tested the feasibility of a partnered workflow between pharmacists and doctors to identify, action and communicate deprescribing recommendations to reduce sedative and anticholinergic burden.
Methods: A partnered deprescribing trial was commenced on two geriatric rehabilitation wards from April 2024. Pharmacists used an electronic Deprescribing Opportunity Identification Tool (DO-IT) to identify sedative and anticholinergic PIMs and document deprescribing recommendations. Doctors used these recommendations to facilitate deprescribing decision-making during ward rounds. Pharmacists ensured changes to preadmission medicines were documented in discharge summaries for the general practitioner (GP). Evaluation was performed for patients discharged home.
Results: From April-May 2024, 71/85 (84%) rehabilitation patients admitted with sedatives or anticholinergics had DO-IT assessments documented by a pharmacist. For assessed patients, 48/71 (68%) had a recommendation to deprescribe a total of 69 PIMs. 32/69 (46%) PIMs were reduced or stopped in hospital. For PIMs that were changed compared with preadmission (new/stopped/dose changed), 35/37 (95%) changes were accurately documented in the discharge summary.
Conclusions: A partnered workflow between pharmacists and doctors facilitates hospital deprescribing of PIMs and helps to ensure changes to preadmission medicines are documented in discharge summaries. Further work is required to support routine use of DO-IT and to encourage documentation of deprescribing recommendations for GPs when in-hospital deprescribing is not feasible.