Implementation of a Standardized Palliative Care Pharmacist Deprescribing Assessment.

Abstract

Background: Palliative care (PC) patients are at high risk of polypharmacy, thereby imposing a substantial burden on patients, including increased pill burden, adverse drug events, and falls. PC pharmacists play a critical role in deprescribing and aligning medications with goals of care for this population, but few studies demonstrate deprescribing opportunities. Objectives: The purpose of this study was to (1) summarize deprescribing opportunities among a sample of hospitalized PC patients, (2) identify patient variables associated with deprescribing opportunities, and (3) summarize deprescribing recommendations, implementation, and short-term clinical harm outcomes. Design: We conducted a retrospective review of the electronic health record. Setting/Subjects: All adult patients across six hospitals in Washington, DC, and Maryland referred to inpatient PC consultation service during the study period were included in this study. Results: Among 125 patients referred to the PC service, 84.5% were evaluated by a PC pharmacist for deprescribing opportunities, and 39.2% were appropriate for deprescribing. There was an average of 3.4 deprescribing recommendations made per patient. White patients and patients with higher severity of illness were significantly more likely to be deprescribing appropriately. The most commonly deprescribed medication classes were bowel regimens and electrolyte repletion, vitamins, and fluids. Deprescribing recommendations were widely accepted by inpatient primary care teams and patients and their caregivers. No short-term clinical harm was observed for patients with deprescribing recommendations implemented. Conclusion: Approximately two in five PC patients in this study were appropriate for deprescribing. PC pharmacists are effective at assessing and implementing deprescribing opportunities.