Exploration of home care nurse’s experiences in deprescribing of medications: a qualitative descriptive study

Abstract

ObjectivesThe aim of this study is to explore the barriers and enablers of deprescribing from the perspectives of home care nurses, as well as to conduct a scalability assessment of an educational plan to address the learning needs of home care nurses about deprescribing.MethodsThis study employed an exploratory qualitative descriptive research design, using scalability assessment from two focus groups with a total of 11 home care nurses in Ontario, Canada. Thematic analysis was used to derive themes about home care nurse’s perspectives about barriers and enablers of deprescribing, as well as learning needs in relation to deprescribing approaches.ResultsHome care nurse’s identified challenges for managing polypharmacy in older adults in home care settings, including a lack of open communication and inconsistent medication reconciliation practices. Additionally, inadequate partnership and ineffective collaboration between interprofessional healthcare providers were identified as major barriers to safe deprescribing. Furthermore, home care nurses highlighted the importance of raising awareness about deprescribing in the community, and they emphasised the need for a consistent and standardised approach in educating healthcare providers, informal caregivers and older adults about the best practices of safe deprescribing.ConclusionTargeted deprescribing approaches are important in home care for optimising medication management and reducing polypharmacy in older adults. Nurses in home care play a vital role in medication management and, therefore, educational programmes must be developed to support their awareness and understanding of deprescribing. Study findings highlighted the need for the future improvement of existing programmes about safer medication management through the development of a supportive and collaborative relationship among the home care team, frail older adults and their informal caregivers.

Health professionals perception and beliefs about drug- related problems on polymedicated older adults- a focus group study

“…Previously studies reported that there are problems when transferring information between healthcare facilities and that this problem is critical when they intend to deprescribe medicines [30][31][32][33]. For this reason, the development of deprescribing approaches is essential for optimizing medication management and reducing polypharmacy in older adults [34,35].…”

The Development of a Deprescribing Competency Framework in Geriatric Nursing Education

“…Although these barriers may exist, they can be overcome with strong, trustworthy multidisciplinary involvement to promote medication optimization. Providing education and training about interprofessional communication and collaboration within the nursing curriculum will allow geriatric nurses to develop effective communication skills and meaningful partnership to facilitate deprescribing conversations, as well as shared decision-making within the circle of care network involving older adults, caregivers, and health care professionals (Sun, Tahsin, Barakat-Haddad, et al, 2019).…”

“…This includes the identification of inappropriate medication, creation of goals and/or plans to either halt or taper off the medication, proper observation, assessment, and patient teaching (Naughton & Hayes, 2016). However, based on past research, nurses often lack the knowledge (Lim et al, 2010), attitudes, and skills required to successfully support deprescribing practices (Hermanowski et al, 2016;Sun, Tahsin, Barakat-Haddad, et al, 2019). Incorporating deprescribing education at the undergraduate level may provide student nurses with the foundational knowledge related to polypharmacy and medication management, which in turn will equip the prospective nurses in developing the competency needed to advocate for and participate in the deprescribing process in their future practice.…”

Educating Homecare Nurses about Deprescribing of Medications to Manage Polypharmacy for Older Adults

“…Our larger research initiative consisted of three phases: Phase 1, a scalability assessment which involved conducting focus group sessions to assess homecare nurses' learning needs about deprescribing of medications for older adults in the community; Phase 2, the development of a scale-up plan, including developing deprescribing learning modules based on focus group findings from Phase 1 to address homecare nurses' educational needs; and Phase 3, implementation of the scale-up educational plan to pilot-test the deprescribing learning modules with homecare nurses in Ontario, Canada. The study findings from Phase 1 and 2 were presented together and have been published (Sun, Tahsin, Barakat-Haddad et al, 2019).…”

“…Despite the existence of practice guidelines about safe medication management, researchers found that at least 25% of community dwelling, non-hospitalized, older adults experienced inappropriate prescriptions of medications from their health care providers (Reeve et al, 2013). Current literature highlights the risks of polypharmacy among older adults which necessitate the need for medication optimization and interprofessional collaboration to raise awareness about safety in medication management in the community (Sun, Tahsin, Barakat-Haddad et al, 2019). Deprescribing is an important way of optimizing medication management and reducing polypharmacy for older adults, which involves the process of tapering, adjusting or discontinuing medication when it is deemed inappropriate or is considered no longer medically necessary (…”