The Importance of Deprescribing and How Technology Can Help You and Your Patients
Deprescribing is a meaningful conversation that clinicians need to have with their patients once admitted into hospice. Many times, when patients come into hospice care, they are over-prescribed medications that they don’t need to be on at all.
It’s the clinician’s responsibility to ensure their patients receive the proper treatment while in hospice care and are educated on the importance of deprescribing.
Throughout this article, we will dive into the ins and outs of deprescribing, best practices for clinicians to follow, common challenges, and how technology can play a vital role in the conversation.
The Importance of Deprescribing
Deprescribing is when a clinician tapers or stops their patient’s medication that is causing harm or is no longer beneficial to the patient. It can be seen as a part of good prescribing: tapering when a dosage is too high or stopping medications completely when it’s no longer needed.
When patients are admitted to hospice care, they may already be prescribed a number of medications they have been taking for years. Upon the first visit, clinicians must have a conversation with the patient and their family about which medicines are necessary for survival and which ones may be doing more harm than good. By identifying any unnecessary medications the patient is taking, clinicians can set a goal for deprescribing and begin the process of easing off medication.
Best Practices for Clinicians When Deprescribing
There isn’t necessarily a script clinicians need to follow when starting the conversation of deprescribing. It ultimately depends on the situation, the clinician, and what works best for the patient.
The FRAME tool provides ideas on how to approach the deprescribing conversation. Below describes what the tool is and examples of how it can be used.
The FRAME Tool
The FRAME tool is a guideline to help clinicians begin the conversation about deprescribing. Although deprescribing is a tough conversation, it’s essential to help a patients’ quality of life and happiness.
F: Fortify trust and build relationships
Clinicians should build a relationship with their patients and keep the line of communication open.
Ex. “How do you feel about taking these medications?”
R: Recognize patient’s willingness or barriers to deprescribing
Clinicians should have open-ended questions with patients:
Ex: “Are some of these medications hard to take?”
A: Align deprescribing recommendations with goals of care
Clinicians should focus on deprescribing the medications that cause rapid decline or significantly impact the quality of life.
Ex: “This medication seems to decrease your appetite and is causing severe fatigue.”
M: Manage cognitive dissonance
Patients might see giving up medication as a sign of giving up, or families might see it as causing more harm than good.
Ex: “I’ve been taking this medication for years. Am I giving up if I stop taking them?”
E: Empower patients and caregivers to continue the conversation
Clinicians should encourage patients to continue the conversation of deprescribing and remind them that the discussion will always be open through their journey together.
Ex: “If you have any questions at all about why we are taking you off a certain medication, we can always talk about it at any time.”
Challenges/Barriers with Deprescribing
Deprescribing may sound like an easy solution, but many challenges and barriers come with deprescribing medications. Below are a few examples of obstacles that clinicians commonly face:
A recent survey found that 72 percent of clinicians were comfortable with deprescribing patients, while only half were comfortable with deprescribing guideline-recommended therapies and preventative medications.
Clinicians should have confidence when bringing up the conversation of deprescribing with their patients and families. It is challenging, but clinicians need to exude confidence with their patients sensitively and passionately so they don’t become distressed.
Fear of Triggering Distress in Patients
Some clinicians may not feel comfortable having the deprescribing conversation with their patients for fear of causing stress to the patient and their family. They don’t want to worry their patient about letting go of all the medication they have been reliant on for many years.
Clinicians may have to pass through a gatekeeper like a receptionist to try and even get ahold of the physician, and even then, they may reach the physician’s voicemail. It all depends on the physician and how easily accessible they are during the day.
When a clinician finally gets ahold of the physician, they must be well-prepared and concise with what they want to discuss as they may only have five minutes to discuss the patient’s medication.
Clinicians need to be confident, well-prepared, and concise when approaching a physician about deprescribing. They are on the same team and want the same thing: their patient to be happy and healthy.
To Taper or To Stop Medication?
Did you know 92 percent of patients have said they would be willing to stop taking one or more of their medications if their physician said it was possible?
However, even if the patient has agreed to deprescribe some of their medication, the clinician may not stop the drug immediately due to the high dosage, length of time, patient, and prescribed type. Instead, the clinician may start tapering the medication even if the patient can’t stop the medication cold turkey.
Tapering is an excellent way to wean the patient off the medication and eventually stop taking it. It prevents the patient from experiencing any severe side effects they may experience if they stopped immediately.
Technology and the Importance of Deprescribing
With how vital deprescribing is, a clinician needs to have the right technology aiding them every step of the way. Hospice agencies need to ensure that their clinicians have a suitable EMR to keep track of information, communicate efficiently, and track data in near real-time.
KanTime’s enterprise, web-based software solution allows clinicians to document with ease and keep track of medication records for each patient.
The software also can provide generic user permission, if the agency wishes, for external patient MDs that are configurable to permit access to an appropriate, limited list of patients.
KanTime does it right the first time and manages by exception, so clinicians can confidently start the conversation of deprescribing and continue to keep track of their patients’ medications while in hospice care. The importance of deprescribing begins with the right technology partner with hospice agencies.