Background: A lack of clear guidelines for medication cessation has contributed to the proliferation of polypharmacy. Hospitalisation provides a unique opportunity for initiating deprescribing. Deprescribing interventions are usually pharmacist-or multidisciplinary team-led and are typically safe and beneficial for patients. However, few studies have explored interventions that are implementable by clinicians at the bedside. Aim: To explore the efficacy and feasibility of a clinician-led deprescribing intervention on an acute general medicine ward. Method: A multifaceted intervention was implemented comprising (a) education sessions on deprescribing and (b) a deprescribing alert in the bedside folders of patients with hyperpolypharmacy (>10 medications). Using a historical cohort study design, data from the intervention cohort were compared to a historical control group. A subset of the intervention cohort was surveyed after discharge regarding attitudes toward deprescribing. Results: We recruited 1333 patients and had complete data for 1169 (n intervention = 888, n control = 281). The prevalence of hyperpolypharmacy decreased from 28% to 26% in the intervention cohort, but this reduction was not statistically significant (net change = À1, interquartile range [IQR] = À2-0; p = 0.26). There was similarly no statistically significant change in medication numbers due to the intervention across other subgroups. Most patients agreed they were taking too many medications and supported deprescribing. Conclusions: Despite observing no statistically significant effect of the intervention, we demonstrated the feasibility of introducing clinician-led deprescribing interventions in resource-poor, busy inpatient units. Simple, innovative deprescribing interventions in hospital settings, along with the measurement of long-term patient outcomes and medication adverse effects, should be investigated further in large inpatient cohorts.
Background Prescribing errors not only impose safety risks, but also delay hospital discharges and adversely affect patient satisfaction. The effect of reducing environmental interruptions on prescribing errors has not been published previously. Aim The aim of this study was to determine the combined effect of two ‘do not disturb’ (DND) strategies in decreasing the average number of prescribing errors by reducing distractions during discharge prescription writing. A secondary aim was to assess the effect of the interventions on prescription correction time. Methods In all, 392 discharge prescriptions from two general medical wards of a teaching hospital were audited over a 10‐week period in a prospective interventional before‐and‐after audit. Clinical pharmacists collected data on the number and type of errors, and time taken to correct errors. DND vests and workstations were made available during the intervention phase. Junior medical officers (JMO) provided daily feedback to the nurse unit managers (NUM) on the number and source of distractions, as well as the use of DND vests and workstations after the intervention. Results The percentage of error‐free discharge prescriptions increased from 29.7% before to 51.5% after the intervention (p < 0.0001). The mean number of errors per prescription decreased from 1.7 to 1.1 (p < 0.01) in both wards combined. The median time taken to correct erroneous prescriptions did not change significantly. Feedback provided by JMOs showed a marked reduction in interruptions, with 73% stating they were not interrupted at all or just once during prescribing after the intervention, compared with 17% before the intervention. Conclusion DND strategies decreased the rate of erroneous prescriptions.
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