124 Revisiting polypharmacy in the hospice in-patient setting

Background Polypharmacy continues to be a concern in the palliative care population. Potentially Inappropriate Medications (PIMs), with no short-term benefit, contribute to pill burden, poor concordance and adverse drug events (ADEs). An initial study, carried out in two hospice in-patient units found that 40% of patients were discharged on 10 or more medications and 83% were prescribed at least one PIM. A deprescribing tool was implemented as part of a polypharmacy quality improvement project, based on Lindsey et al’s guideline for deprescribing unnecessary medications in the palliative population. Aim To identify whether the introduction of a deprescribing tool, to aid doctors in discussions about rationalising PIMs, reduces the number of unnecessary medications and total number of medications on discharge. Method 63 inpatient notes (21 discharges, 42 deaths) were audited using the original audit proforma. For discharges; the number of medications pre and post admission were recorded. Additionally, the number of PIMs prescribed and the number of medications rationalised on admission were recorded. Standards remained the same as the original study: 80% of medications with limited benefit to be stopped and 80% of patients to be discharged on 7 medications or less. Results 71% of all patients were on at least one PIM pre-admission compared to 83% previously (pre-tool). 43% of patients were discharged on 7 or less medications, an increase from 38% in the initial audit. There was a 50% reduction in the total number of PIMs prescribed from admission to discharge. 65% patients had at least one drug rationalised on admission. Only 66% of patients went home on at least 1PIM compared to nearly 80% in the initial audit. Conclusion The deprescribing tool is beneficial in helping prescribers to recognise polypharmacy and consider rationalising medications, specifically PIMs, in hospice inpatients.