Deprescribing

For General Information on Deprescribing from a Vendor of Decision Making Support Software. https://www.medsafer.org/resources-helpful-links

See results of multicenter controlled trial: McDonald EG, Wu PE, Rashidi B, et al. The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial. JAMA Intern Med. Published online January 18, 2022.  https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2788297?guestAccessKey=12ed1491-5a39-4819-ae02-f64779e9d37f&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=011822

FOR Local Protocol for Deprescribing (Smart phrase in EPIC .JTDEPRESCRIBE)

[i} Consider a review of the patients pharmacy genetic profile (PGx)

Results may inform dosing adjustments or enhanced drug-drug interaction based on pharmacokinetics
Ordered: y/n ***

Rationale or results: ***
1 Ascertain all meds [ .meds]
2 Consider overall risks of drug-induced harm (eg Beers criteria, etc)

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3 Assess each drug for eligibility for discontinuation according to individualized benefit risk assessment ***
4 Prioritize Drugs for discontinuation

Drug Benefit Harm
*** *** ***
*** *** ***
*** *** ***
*** *** ***
*** *** ***

5 Implement Drug Discontinuation Plan
For ****.
Above drug selected due to ****
Reduce by *** per ***

Monitor for ***

Deprescribing Protocol : Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. May 2015;175(5):827-834

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[i] genetic testing step added Thornton JE based on article :

ElchynskiL AL et al 2021 . Determining the potential clinical value of panel-based pharmacogenetic testing in patients with chronic pain or gastroesophageal reflux disease. Pharmacogenomics J. 2021 Jun 1 . Epub ahead of print. PMID: 34075203.