| ❑ | Discontinue medications |
|---|
| |
Medications that are often unnecessary, provide no to minimal clinical benefit, e.g.,
- Iron, vitamins including multivitamins, Vitamins A, B1, B3 (Niacin), B6 (Pyridoxine), E, Biotin, Coenzyme Q10
- Herbal medications: e.g., Ginkgo Biloba, Ginseng, Valerian Root, Echinacea, Red Yeast Rice, Garlic, Saw Palmetto, Flaxseed
- Others: Docusate, cranberry tablets, glucosamine, low-dose fish oil, probiotics, appetite stimulants
Medications often discordant with goals of care and potential time to benefit, e.g.,
- Long-term preventive medications (e.g., aspirin, statins) in residents with comfort-oriented care goals or limited life expectancy
Medications appropriate in many residents but safe to temporarily discontinue, e.g.,
- Calcium, magnesium, bisphosphonates, Vitamin B12, Vitamin D
|
| ❑ | Reduce frequency of medication-associated monitoring |
|---|
| |
- Reduce frequency of monitoring (e.g. heart rate, finger sticks) to track drug effects especially if resident is stable and prior monitoring values/parameters stable. If appropriate, discontinue medications that require frequent monitoring.
|
| ❑ | Reduce medication dosing frequency |
|---|
| |
- Change from short- to long-acting formulations, e.g., metformin, metoprolol, carvedilol, diltiazem, others
- Change analgesic regimens to allow greater spacing between doses, consolidate laxatives
- Switch from short- to long-acting insulins, reduce PPIs from twice daily to daily or discontinue
|
| ❑ | Change timing of doses |
|---|
| |
- Move statins (e.g., atorvastatin), alpha blockers (e.g. tamsulosin), levothyroxine to consolidated dosing times
|
| ❑ | Administer medications differently |
|---|
| |
- Change medications that require crushing to liquid formulation if possible; consider liquid/powder potassium
|
| ❑ | Consolidate administration times |
|---|
| |
- Consolidate dispensing times - e.g., q12 hours to BID, eliminate outlier medication administration times
- Liberalize allowable time period to administer meds
|
| ❑ | Reduce risks of COVID-19 transmission |
|---|
| |
- Use hand-held inhalers (with spacer if possible) instead of nebulizers; consider product(s) availability and usability
- Where appropriate, change acetaminophen from regular to as-needed dosing to aid in COVID-19 fever surveillance
- Where possible, avoid directly touching residents when passing meds
- Reduce unnecessarily frequent monitoring; identify alternatives for meds that require frequent administration
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