Incorporating a Student Pharmacist in the Deprescribing Process for Long-Term Care Patients
by Jenna N Harnish, 2025 PharmD Candidate, Mara A Kieser, MS, RPh, BCGP
"Background: Polypharmacy is defined as the use of five or more medications and is highly prevalent in long-term care facilities (LTCFs). Patients aged 65 or older are at a greater risk of unintended adverse events, such as falls and cognitive impairment, due to polypharmacy.
Objective: Quality improvement project describing the benefits of incorporating a student pharmacist into the deprescribing process and evaluating the need to deprescribe therapies to reduce falls and potentially inappropriate medications (PIMs).
Methods: Student pharmacist assessed patient profiles for high fall risk medications and PIMs. Medications recommended for tapering were level 1 or 2 fall risk and/or PIMs with any adverse event on the American Geriatrics Society (AGS) Beers Criteria. Medications recommended for discontinuation were level 3 fall risk and PIMs with any adverse event on the AGS Beers Criteria.1
Results: Every patient identified for the project was taking at least one medication that put them at a greater risk of falling, and 10% were taking at least one PIM. High fall risk medications were the most common with
a mean use of 6 medications per patient, whereas the use of PIMs had a mean of 3 medications per patient. Total medication use of all patients included was 1,002 medications with 330 targeted for deprescribing due to posing a high fall risk and/or being a PIM with any adverse event.
Conclusion: Pharmacists and student pharmacists have an opportunity to play a more significant role in deprescribing medications. Student pharmacists are a beneficial addition to the medication review and deprescribing process."
Keywords: Aged, Potentially Inappropriate Medication List, Deprescriptions, Pharmacists, Polypharmacy, Accidental Falls, Long-Term Care, Medication Review, Quality Improvement, Cognitive Dysfunction, Students
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2024 May/June Table of Contents
"Background: Polypharmacy is defined as the use of five or more medications and is highly prevalent in long-term care facilities (LTCFs). Patients aged 65 or older are at a greater risk of unintended adverse events, such as falls and cognitive impairment, due to polypharmacy.
Objective: Quality improvement project describing the benefits of incorporating a student pharmacist into the deprescribing process and evaluating the need to deprescribe therapies to reduce falls and potentially inappropriate medications (PIMs).
Methods: Student pharmacist assessed patient profiles for high fall risk medications and PIMs. Medications recommended for tapering were level 1 or 2 fall risk and/or PIMs with any adverse event on the American Geriatrics Society (AGS) Beers Criteria. Medications recommended for discontinuation were level 3 fall risk and PIMs with any adverse event on the AGS Beers Criteria.1
Results: Every patient identified for the project was taking at least one medication that put them at a greater risk of falling, and 10% were taking at least one PIM. High fall risk medications were the most common with
a mean use of 6 medications per patient, whereas the use of PIMs had a mean of 3 medications per patient. Total medication use of all patients included was 1,002 medications with 330 targeted for deprescribing due to posing a high fall risk and/or being a PIM with any adverse event.
Conclusion: Pharmacists and student pharmacists have an opportunity to play a more significant role in deprescribing medications. Student pharmacists are a beneficial addition to the medication review and deprescribing process."
Keywords: Aged, Potentially Inappropriate Medication List, Deprescriptions, Pharmacists, Polypharmacy, Accidental Falls, Long-Term Care, Medication Review, Quality Improvement, Cognitive Dysfunction, Students
Download PDF
2024 May/June Table of Contents