Home' Australian Pharmacist : Australian Pharmacist October 2015 Contents Australian Pharmacist October 2015 I ©Pharmaceutical Society of Australia Ltd.
Polypharmacy and multimorbidity are common in residential aged care
facilities. Reducing polypharmacy may reduce adverse events and maintain
quality of life.
The term ‘deprescribing’ has become
popular over the past few years.
As many as one in five RMMR
recommendations to General Practitioners
(GP) may relate to deprescribing. But it
can be disappointing when not all
recommendations in your reports are
adopted and acted upon by the GP.
Recent deprescribing research focusing on
residential aged care facilities shows that
deprescribing is not always simple and
that there can be a number of barriers.
In South Australia discipline-specific
groups of GPs, nurses, pharmacists and
residents/representatives were asked
to rank factors they thought were most
important in deciding whether or not to
A metropolitan and regional
multidisciplinary group which included
resident representatives then prioritised
the results, and found that no two
disciplines had the same priorities.
GPs ranked ‘evidence for deprescribing’
and ‘communication with family/
resident’ as the most important
influence. For nurses, ‘GP receptivity
to deprescribing’ and ‘nurses ability to
advocate for residents’ were the priorities.
Pharmacists ranked ‘clinical
appropriateness of therapy’ and
‘identifying residents’ goals of care
as most important, while residents
chose ‘wellbeing of the resident’
and ‘continuity of nursing staff ’.
The multidisciplinary groups gave the
top rankings to ‘adequacy of medical
and medication history’ and ‘identifying
residents’ goals of care’.
These findings are consistent with a
recent Australian systematic review
identifying prescribers’ barriers
and facilitators to deprescribing
inappropriate medications in adults.
As well as ‘good communication with
the family and resident’, the review
also stressed the importance of good
communication between the prescriber
and medical specialists and other
health professionals – particularly
communication with nurses in aged
care facilities, and pharmacists through
One of the barriers highlighted by the
review was fear; this included concerns
about medication withdrawal reactions
and that symptoms would return.
This and other research on
deprescribing is important, and
has implications for the way that
accredited pharmacists undertake
reviews in aged care. It highlights ways
in which to increase the number of
recommendations acted upon by the GP.
An example is when an accredited
pharmacist recommends ceasing a
complementary therapy such as a
‘probiotic product’. In the review you
should state that ‘I have talked with Mrs
XX (or her family/ next of kin) and she is
happy for this medicine to be ceased if
you deem appropriate. This addresses
the priority of ‘communication with the
The South Australian research
highlighted that communication with
the family/resident could either help or
hinder deprescribing. The time involved
» ACCREDITED PHARMACIST SPECIAL INTEREST GROUP
BY JUSTIN TURNER
Justin Turner is a PhD candidate working at the Centre
for Medicine Use and Safety at Monash University,
in discussions and communication with
residents could be a barrier. However the
process can be assisted if the GP already
has in writing that the family or resident
is happy for the change to occur
Similarly, the fear barrier associated
with deprescribing a Proton Pump
Inhibitor (PPI) can be overcome by
providing the GP with a deprescribing
guideline detailing how to reduce PPIs
to minimise adverse withdrawal affects
and return of symptoms. The GP can
be further reassured if you are able to
state that you have spoken with Mr YY
(or his family/next of kin) and nursing
staff, and explained that it is a ‘trial of
deprescribing’ and the medication can be
restarted if symptoms return.
Another facilitator raised by residents in
the South Australian study related to the
acceptability of the medication dose form.
Residents were happy to deprescribe
medications that were difficult to swallow
due to their size, tasted terrible once
crushed, or were difficult to administer;
for instance, some inhalers are easier
to use than others. Pharmacists have a
unique knowledge of dose forms and are
able to provide valuable assistance with
deprescribing, or changing to a more
The RedUse project and research
(Reducing the Use of Sedatives) involves
a multidisciplinary team consisting of
the nursing staff, GPs, the pharmacist
who provides Quality Use of Medicines
services, and the pharmacist providing
supply service to the RACF. This research
by the University of Tasmania has also
highlighted the role of the nursing staff
in reducing the use of sedatives; this is
supported by international research.
To enable deprescribing for better
patient outcomes the accredited
pharmacist must not only have
excellent clinical knowledge, but also
excellent communication skills and an
understanding of the factors involved.
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