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Impact of deprescribing rounds on discharge prescriptions: an interventional trial

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Abstract

Background Successful deprescribing practices are required to address issues associated with polypharmacy but are hindered by minimal interprofessional collaboration, time constraints, concern for negative outcomes, and absence of a systematic and evidence-based approach. Objective Determine the impact of pharmacist-led deprescribing rounds within a clinical teaching unit (CTU) the number of home medications discontinued upon hospital discharge. Setting Canadian tertiary care hospital. Methods Prospective, dual-arm, interventional study conducted in a single centre, from November 23rd, 2015 to August 30th, 2016. All patients ≥ 19 years old admitted under the CTU were considered for enrolment if on medication(s) prior to admission and patients were excluded if not taking any medications. Study arm allocation alternated daily between the two teams. The control arm operated as per standard whereas the intervention arm’s pharmacist used a deprescribing guide and medication review to identify medications eligible for discontinuation prior to discussing during daily rounds. Discharge documents communicated medication changes to patient and primary healthcare providers. The study was sufficiently powered. Main outcome measure The difference of number of home medications discontinued at discharge between the intervention and control groups. Results 171 and 187 patients were allocated to the intervention and control arms, respectively. No significant differences of baseline characteristics existed between groups. Main outcome measure results showed that deprescribing rounds resulted in significantly more medications deprescribed compared to control (65% vs. 38%; p = 0.001). The rates of readmission and emergency department visits were reduced in the intervention arm. Conclusions Incorporating deprescribing rounds into routine care led to significantly greater discontinuation of medications without increasing rate of emergency department visits or hospital admissions.

Trial registration ISRCTN11751440

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Authors and Affiliations

  1. Department of Pharmacy, Nanaimo Regional General Hospital, 1200 Dufferin Crescent, Nanaimo, BC, V9S 2B7, Canada

    Rachel Edey

  2. Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada

    Rachel Edey, Nicholas Edwards & Dan Martinusen

  3. Department of Pharmacy, Royal Jubilee Hospital, 1952 Bay St, Royal Block 242, Victoria, BC, V8R 1J8, Canada

    Nicholas Edwards, Ajay Bains & Dan Martinusen

  4. Internal Medicine, Royal Jubilee Hospital, 1952 Bay St, Victoria, BC, V8R 1J8, Canada

    Jonah Von Sychowski & Jim Spence

  5. Island Medical Program, The University of Victoria, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada

    Jonah Von Sychowski & Jim Spence

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  1. Rachel Edey
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Correspondence to Rachel Edey.

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Authors Rachel Edey, Nicholas Edwards, Jonah Von Sychowski, Ajay Bains, Jim Spence, and Dan Martinusen do not have any conflicts of interest to disclose or financial interests to declare.

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Edey, R., Edwards, N., Von Sychowski, J. et al. Impact of deprescribing rounds on discharge prescriptions: an interventional trial. Int J Clin Pharm 41, 159–166 (2019). https://doi.org/10.1007/s11096-018-0753-2

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  • DOI: https://doi.org/10.1007/s11096-018-0753-2

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