Background A lot of studies emphasise the incidence of serious harm caused by polymedication in elderly patients. The use of benzodiazepines and/or combinations with other psychoactive medications in particular can increase the risk of confusion, falls, cognitive impairment and other adverse drug events.
Purpose To guard the safety and quality of life of geriatric patients receiving polymedication by reducing the use of psychoactive medication in a multidisciplinary way with the clinical pharmacist, geriatrician, general practitioner and home pharmacist.
Material and methods During a test conducted over 5 weeks, patients were screened. Inclusion criteria were the presence of a contraindication for benzodiazepines, a dose equivalent to 20 mg diazepam or a pharmacodynamic synergistic interaction (antidepressant, antipsychotics, anticholinergics, sedative antihistaminics and opioids). The clinical pharmacist informed the patient about the impact of benzodiazepines. If the patient agreed to reduce the psychoactive medication, the geriatrician and general practitioner were contacted to decide which medication to reduce and to confirm the reduction schedule.
Results In the test, 30 patients met the inclusion criteria. 6 were not approachable, and in 4 patients the psychoactive medication had already been stopped in the hospital. 70% of the patients informed agreed to reduce their psychoactive medication. 10% were excluded by the geriatrician, and for 15% a reduction was suggested via the discharge letter. The general practitioner always supported the effectuation of the reduction.
This project resulted in the development of a multidisciplinary workflow and some practical tools that can be used by any doctor or pharmacist.
Conclusion Deprescribing psychoactive medication for elderly people can successfully be implemented by the development of a multidisciplinary workflow (clinical pharmacist–specialist–general practitioner–home pharmacist) and by providing some practical tools.
Our goal of patient safety could be achieved and led to satisfaction of patients and caregivers.
References and/or Acknowledgements STOPP criteria, https://www.nhg.org/sites/default/files/content/nhg_org/uploads/2015-05-07_stoppcriteria_eindversie_pdf.pdf
Beers criteria, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571677/
No conflict of interest.
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