Date of Award

Spring 5-30-2021

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Dr. Caroline Etland PhD, RN, CNS, ACHPN

Second Advisor

Dr. Tracie Gadler DNP, APRN, FNP-C

Abstract

Current evidence recommends and supports deprescribing medications to reduce polypharmacy in the hospice population. The project aim was to determine accurate percentages of deprescribing at three time periods: before hospice admission, at hospice enrollment, and four weeks post hospice enrollment. This project was a retrospective review of the medication administration record (MAR) of patients admitted into Sharp Hospice from a Sharp Healthcare facility. Sharp Hospice, in California, USA, admitted 164 patients during August 2020. Of those, 34 patients were eligible for inclusion in this retrospective quality improvement review. Prior to discharge from a Sharp facility, the percentage of target medications on the inpatient medication record equaled 80.5% for antihypertensives, 61.1% for statins, and 22.2% for oral diabetic medications for the sample. At hospice admission, 61.0 % of these patients were appropriately deprescribed, 13.8 % of patients were partially deprescribed, meaning some eligible medications were removed, and 25% of patients were not deprescribed. 64 % of patients were appropriately deprescribed target medications during the first four weeks of hospice enrollment. The results confirmed medication deprescribing is occurring but also identified missed opportunities for deprescribing in Sharp Hospice. These conclusions are beneficial and applicable to the next phase of project implementation to improve the organization's deprescribing percentages.

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