I’ve been doing quite a bit of long term care consulting lately and I’ve been trying to pay attention to which medications and medication classes I have been targeting in an effort to reduce polypharmacy. Here are my top 5 targets to reduce medications in long term care. Also be sure to check out my course on LTC consulting!
Complaints of insomnia are extremely common in patients who have recently transitioned from various settings into new environments. It is critical to make sure that sleep medications are reevaluated frequently. If you put yourself in the shoes of your patients, you would understand that sleeping in a new bed and environment is very likely to upset your sleeping status quo. Once a patient has stabilized at a new location, ensure that any medications used for sleep are subsequently tapered to the minimum effective dose or ideally discontinued. Melatonin, zolpidem, trazodone, mirtazapine, and diphenhydramine are the most common sleep agents that I have been seeing lately.
The use of PPIs is incredibly high in hospital and long term care settings. GI prophylaxis is often used in the hospital and many times this is continued when a patient is transitioned to long term care. Pay close attention as to when that PPI (or H2 blocker) was started and also why it was started. This can help us understand if it is truly necessary on a long term basis. In many instances, we can taper the dose down and often discontinue.
With so many rehab patients now in long term care, we can oftentimes reduce and eliminate pain medications as patients continue to improve. Tapering opioids, gabapentin, NSAIDs, and other pain relieving medications have been something I’ve been paying attention to lately. Also, remember that non-drug interventions can play an important role in alleviating pain and reducing medication burden.
Similar to pain, many rehab patients may have had behavioral issues in the hospital. These hospital-related issues may have led to the addition of various psychotropic medications like antipsychotics and benzodiazepines. It is critical to identify the indication for use of these medications and recognize if they have been on board for a short period of time or a longer period of time.
When the call is made to place a patient on hospice, this is an excellent time to review all the supplements that the patient is taking. Many take supplemental vitamins in addition to a multiple vitamin and if diet is adequate, it is often unnecessary. I also find myself looking at iron supplements. When hemoglobin is within normal limits and the patient has adequate iron stores, we can definitely look to get rid of these and monitor hemoglobin going forward.
What other targets to reduce medications in long term care are you pursuing?