Abstract
Polypharmacy amongst older adults causes adverse drug events, prescription cascades, injurious falls, and increased costs. Medication list reviews is an evidence based deprescription methodology. The planned project intervention was to implement a deprescription process change for rehabilitation patients and to measure provider self-efficacy deprescribing practices before and after implementation of the process change. Anticipated outcomes included deprescribing self-efficacy enhancement, polypharmacy reduction, and readmission and fall decreases. An approved list of 16 Beers Criteria medications was formulated by the project site including first-generation antihistamines, hypnotics, benzodiazepines, and anticholinergics. Upon rehab admission, nurses entered admission medications into the electronic record from hospital discharge orders excluding any of the 16 medications. If medications from the condensed Beers list were not placed into the record upon admission, prescribers were immediately phoned at which point prescribers could continue the medication or deprescribe. Deprescription self-efficacy of prescribers was measured through the validated Farrell Deprescribing Self-Efficacy Survey pre and post implementation of the admitting process change. Patients who underwent deprescription (32%) and patients who did not undergo deprescription (32%) were discharged safely showing deprescribing did not significantly alter outcomes, n = 16. Prescriber self-efficacy showed enhanced post implementation scores in certain topics. Overall deprescribing confidence was lower than drug class specific questions. Results further strengthen the importance of establishing methodologies to address deprescribing hesitancies and barriers which include time constraints, heavy workloads, limited guidance from literature or peers, and family or patient resistance.