57 A baseline evaluation of deprescribing practice on a hospice inpatient unit

<h3>Background</h3> Polypharmacy is a well-known issue at the end of life; potential implications include drug interactions, cost, pill burden, and high risk-benefit ratio.¹ Appropriate deprescribing has potential to reduce these issues. As the first stage of a quality improvement project (QIP), this baseline evaluation aimed to assess current deprescribing practice on a 12-bed specialist inpatient unit (IPU), identify areas for improvement and explore introducing a formal deprescribing tool on admission. <h3>Methods</h3> Two methods of evaluation were used: 1) a baseline audit and 2) a staff survey. Clinical notes for consecutive admissions were reviewed retrospectively over a 6-month period for evidence of deprescribing within 7 days of admission. Data was collected with reference to the OncPal deprescribing guideline,² which identifies 7 medication groups with limited benefit in the last 6 months of life, and circumstances in which deprescribing is indicated. Evidence of discussion of deprescribing with patients/relatives was also noted. An online survey was sent to 9 IPU doctors exploring their views about using a formal deprescribing tool, following a brief trial of its use. <h3>Results</h3> 22 of 56 patients (39%) were taking medications with indication to deprescribe including antihypertensives, lipid-lowering drugs, aspirin and vitamins/supplements. Deprescribing occurred for 19 of these 22 patients (86%) but was only documented to have been discussed with 1 patient (5%). Uptake of the formal deprescribing tool was very low. Barriers identified amongst 5 survey respondents included time constraints and the already high burden of admission paperwork. <h3>Conclusions</h3> Appropriate describing occurred within 7 days of admission for the majority of patients in line with published guidelines, suggesting there may be limited additional gain from introducing a formal deprescribing tool. The rate of documented discussion with patients/families was concerningly low. This needs further exploration and will be the focus of the next stage of the QIP. <h3>References</h3> Hedman C, Frisk G, Björkhem-Bergman L. Deprescribing in palliative cancer care. <i>Life (Basel)</i> 2022;<b>12</b>(5):613. doi: 10.3390/life12050613. Lindsay J, Dooley M, Martin J, <i>et al</i>. The development and evaluation of an oncological palliative care deprescribing guideline: the ‘OncPal deprescribing guideline’. <i>Support Care Cancer</i> 2015;<b>23</b>:71–78.