Doctor of Nursing Practice
Family Nurse Practioner
Year Degree Awarded
Month Degree Awarded
deprescribing, polypharmacy, hospice, end of life, pill burden, nurses
Karen Kalmakis PhD, MPH, FNP-BC, FAANP
DNP Project Chair
Hyeyoung Park Ph.D., RN
DNP Project Outside Member Name
Julie Thurston AGPCNP-BC, ACHPN
Background: Polypharmacy can yield various adverse outcomes for patients over the age of 65. The lack of a standardized process and education for hospice nurses to implement into their clinical practice can increase polypharmacy, which burdens patients and families at the end of life.
Purpose: This quality improvement project aimed to increase hospice nurses' knowledge and confidence to initiate deprescribing for non-essential or inappropriate medications with hospice patients.
Methods: A multimodal educational program that incorporated evidenced-based resources composed of STOPP Frail Criteria, Garfinkel algorithm, and the BUILD model was presented at a community hospice agency. Pre- and post-intervention questionnaires were used to assess the hospice nurses' level of knowledge and confidence with deprescribing. Meetings with the hospice nurses and retrospective chart reviews were also conducted to evaluate actual trends of deprescribing at the agency.
Results: The 25 hospice nurses who completed the program demonstrated increased confidence and knowledge of deprescribing, polypharmacy, and the identification of inappropriate medications using the STOPP Frail Criteria and Garfinkel algorithm. There was an increase in patients who had inappropriate medications deprescribed.
Conclusion: Deprescribing and polypharmacy are significant issues that impact older patients at end of life. Ongoing education and evaluation are recommended to improve patients' overall symptom management and quality of life.
Keywords: polypharmacy, deprescribing, end of life, hospice, nurses, discontinuing medications, pill burden
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