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. There are also two companion documents to these videos written by Dr Janz. 

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.

Antidepressants in the Frail Elderly With Dementia and Depression

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

Read this short summary for an overview of Polypharmacy Risk Reduction in Residential Care

Overview of Residential Care

Introduction to 'Building Local capacity & Sustainability' sessions

The goal of the 'Building Local Capacity & Sustainability' (BLCS) sessions is to facilitate discussions with local physicians and others involved in residential care, on improving the approach to inter-disciplinary meaningful medication reviews. The sessions also provided the opportunity to present helpful resources, tools and templates that could be used and adapted by local communities. 

learning outcomes of BCLS Sessions

Physicians will have an awareness of:

  • Risks of polypharmacy risk and how to safely reduce that risk
  • How knowledge of the dementia trajectory, and goals of care, set the context for polypharmacy risk reduction
  • How and when to use clinical resources and strategies to facilitate polypharmacy risk reduction
  • Local interdisciplinary approaches to Meaningful Medication Reviews within the Residential Care Initiative

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:

Links to Session Presentations:

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

In the last few years, there have been a number of locally developed tools across the province, to prepare for medication reviews, usually involving care staff and pharmacists. Mount St. Mary’s hospital in Victoria is a site that developed, tested, implemented and audited a suite of such tools. This approach was found to be very effective and engaging for the staff. These tools 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