Doctor of Nursing Practice (DNP) Projects

Access Control

Open Access

Embargo Period

5-2-2020

Degree Program

Doctor of Nursing Practice

Degree Track

Adult Gerontological Primary Care Nurse Practitioner (AGPCNP)

Year Degree Awarded

2020

Month Degree Awarded

May

Keywords

deprescribing, inappropriate polypharmacy, older adults, potentially inappropriate medications, Beers Criteria, provider education

Advisor

Dr. Raeann G. LeBlanc, PhD, DNP, AGPCNP-BC, CHPN

DNP Project Chair

Dr. Raeann G. LeBlanc, PhD, DNP, AGPCNP-BC, CHPN

DNP Project Outside Member Name

Kim Groner, MSN, RN, ANP-BC, CCRC, NE-BC

Abstract

Background: Adverse drug events (ADEs) are a significant cause of morbidity and mortality in older adults (age ≥ 65). Polypharmacy and potentially inappropriate medications (PIMs) are especially prevalent in this population and are a notable contributing risk factor for ADEs. Research demonstrates that comprehensive medication reconciliation that includes evaluation of both the risks and benefits of medications, in conjunction with deprescribing practices, can reduce PIMs; therefore, reducing ADEs.

Purpose: The aim of this quality improvement project was to empower clinicians to deprescribe current medications that are inappropriate, as well as reduce the rate of newly prescribed PIMs among patients age ≥ 65 in the primary care setting by establishing a multi-modal educational intervention.

Methods: A detailed educational program that incorporated evidence-based resources composed of the American Geriatrics Society (AGS) 2019 Beers Criteria®, PIMs, and deprescribing was introduced to 88 clinicians in a large academic, urban-based general internal medicine primary care clinic. Data was collected through pre-post intervention surveys to assess provider knowledge, prescribing practices, and self-efficacy in deprescribing. A retrospective medication chart review then assessed actual trends of prescribed PIMs in the clinic.

Results: The 34 clinicians who completed each survey demonstrated an increased knowledge of AGS Beers Criteria® medications and reported a greater frequency in medication reconciliation performance. Notably, a paired t-test was performed to measure 13 providers’ reported self-efficacy deprescribing; and each participant’s response improved post-intervention.

Conclusion: Proper medication safety standards in older adults is a complex issue that requires significant education in order for clinicians to adopt informed prescribing practices, thus ongoing provider education and evaluation are recommended. This multi-modal educational intervention is feasible for implementation in various healthcare settings to expand provider knowledge.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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