Deprescribing in Hospice Patients: Discontinuing Aspirin, Multivitamins, and Statins

Abstract

Patients and Methods: During the fall of 2019, we conducted a quality improvement project to improve care of Mayo Clinic Hospice patients by decreasing the percentage of patients taking aspirin, multivitamins, or statins. Project interventions included the addition of a palliative medicine fellow to the hospice interdisciplinary team, nurse education, and implementation of an evidence-based deprescribing resource tool. The resource tool included a communication framework to guide deprescribing conversations and a literature summary supporting deprescribing. The project team recorded the number of patients taking 1 of these medications by intermittently surveying the hospice census. Process and counterbalance measures were tracked with online surveys of hospice nursing staff. Results: At the start of the project, 22 of 69 patients (32%) were taking aspirin, a multivitamin, or a statin. After introduction of the deprescribing resource tool and the addition of a palliative medicine fellow to the interdisciplinary team, this was reduced to 20 of 83 patients (24%), a 24% decrease. Results appeared to be driven primarily by a reduction in multivitamin use (33% decrease). Self-reported comfort and knowledge about deprescribing improved among the hospice nursing staff, as did satisfaction in their workflow from 5.4 to 6.0 (maximum, 7). Conclusion:The addition of a dedicated team member to address medication issues and provision of an evidence-based deprescribing resource tool appear to reduce the use of unnecessary and potentially harmful medications in ambulatory hospice patients.

Optimizing Medications with the Geriatrics 5Ms: An Age-Friendly Approach

“…In conclusion, the Geriatrics 5Ms allow for holistic and adaptable decision making guided by patient preference and evidence-based medicine to optimize medications for patients with (or without) polypharmacy. Age-Friendly medication optimization, including thoughtful deprescribing when appropriate, may improve patient quality of life along with the experience of care for the patient and provider [47,48]. This Age-Friendly approach will benefit medication management for patients across the lifespan [49].…”

Deprescribing statins, considerations for informed decision making

“…Several classes of medications have garnered interest as potential deprescribing targets, including statins. [8][9][10] Given their widespread use and preventative indications, uncertainty of benefits for older adults, and adverse effects, statins seem a prime target for discontinuation. For example, statins were considered "nonessential" and highlighted for discontinuation in a recent study of nursing home patients.…”

“…This has led to a broad interest in deprescribing, the intentional process of tapering, stopping, discontinuing, or withdrawing drugs, with the goal of managing polypharmacy and improving outcomes. Several classes of medications have garnered interest as potential deprescribing targets, including statins 8–10 …”