Polypharmacy Risk Reduction

The following resources have been compiled to support practical physician and inter-disciplinary team approaches to reducing risk from polypharmacy in residential care, acute care, and in the community. Some resources have been designed to be adapted to your own individual setting, if required.

Video Series - Goals of Care Conversations

In this video series, residential care experts Dr. Trevor Janz and Gina Gaspard walk you through conversations with families around end of life goals of care. Conversations cover sensitive issues, such as: what to expect as a loved one's disease progresses (using dementia as a main example), use of antibiotics, hospitalization vs comfort care, and other topics.

 

Dementia roadmaps for families and providers

A Dementia Roadmap for Practioners

When Your Loved One Has Dementia - A Roadmap for Families

 
You Decide Sheets

These brief resources, which have been reviewed by an expert clinical advisory group, provide an evidence summary specific to the elderly, plus a few practice points, for key drug classes. They have been developed to inform medication reviews and decision-making.

Osteoporosis Drugs in the Frail Elderly in Residential Care

Antihypertensive use in the elderly in Residential Care

Proton Pump Inhibitors (PPIs) for the Elderly in Residential Care

Statins in the Older Adult

Antipsychotics in the Treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) in the Elderly

External Initiatives & Resources

Canadian Deprescribing Network and the Deprescribing development groups: https://www.deprescribingnetwork.ca: This site contains many very useful resources for both health professionals and patients. Of particular note for health professionals are deprescribing algorithms for PPIs, antihyperglycemics, antipsychotics, benzodiazepines and cholinesterase inhibitors/memantine: https://www.deprescribingnetwork.ca/algorithms/  or found at: https://deprescribing.org, with more resources.

The PATH Group (Palliative and Therapeutic Harmonization) in Nova Scotia have developed an approach to supporting frail patients and their families to make evidence-informed decisions. Working with others in Nova Scotia, practice guidelines appropriate for the frail elderly have been developed for management of type 2 diabetes, hypertension, statins and depression: https://pathclinic.ca/education/clinical-practice-guidelines/ .

Choosing Wisely Canada. Choosing Wisely is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care. https://choosingwiselycanada.org/geriatrics/, https://choosingwiselycanada.org/psychiatry/ 

Canadian Frailty Network: http://www.cfn-nce.ca  

MedStopper is a deprescribing resource for healthcare professionals and their patients that has been developed at the University of British Columbia, Faculty of Pharmaceutical Sciences with the support of clinical experts from across Canada. It has been found useful to support decision-making around medication use and deprescribing with patients and families. http://medstopper.com/

Numbers needed to treat by specialty. http://www.thennt.com/home-nnt/

GPAC BC Guidelines on Cognitive Impairment and also on Frailty: https://www2.gov.bc.ca/gov/content/health/practitioner-professional-reso... and https://www2.gov.bc.ca/gov/content/health/practitioner-professional-reso...

 
Residential Care

 

Overview of Residential Care

Building local capacity & sustainability - Session 1

The following are templates and supporting documents to assist you as you conduct your own community Polypharmacy Risk Reduction sessions:

BUILDING LOCAL CAPACITY & SUSTAINABILITY - SESSION 2

The following are templates and supporting documents to assist you as you conduct your own community Polypharmacy Risk Reduction sessions:

Resources Supporting Meaningful Medication Reviews

Mount St. Mary’s (Victoria) has developed tools and guidelines to support a team approach to meaningful medication reviews in residential care. These can be modified to suit your particular care setting if required.

Mount St. Mary's Medical QI and Pharm Review
Mount St. Mary's Medical QI and Interdisciplinary Team Medication Review
Chart Reviews by Medical Coordinator
Interdisciplinary Team Medication Reviews

External Resources

The Clear initiative (Call For Less Antipsychotics in Residential Care) is supporting care homes in BC to provide person-centered care for residents with the behavioural and psychological symptoms of dementia (BPSD). There are many resources on the website that support this work. http://www.clearbc.ca