Deprescribing in Long-Term Care Framework

A framework for ensuring deprescribing discussions are part of medication management

People living in LTC homes sometimes take many medications. Preventing the overuse of medication and medication-related harm is a global priority. Decisions about medication use are best made when people partner with their health care providers. Ideally, these decisions consider the perspectives and experience of the person taking them as well as information about medication effectiveness and side effects.  Everyone who cares for a person living in LTC can help make medication-related care safe and effective.

To support people in having discussions about when to continue, reduce or stop a medication, our team worked with the Ontario Centres for Learning, Research and Innovation in Long-Term Care (CLRI) at Bruyère. We conducted an environmental scan with Ontario LTC stakeholders and hosted two Forums in 2019 and 2020. Stakeholders identified behaviours that would help people integrate deprescribing into daily living in LTC and actions that would support these behaviours.

Below, we outline each behaviour and action, providing links to tools that we have designed with our stakeholders.

We’d like to hear from you about whether these tools are helpful, ways in which they could be improved and options for spreading the work to those who might use them.

Target behaviour: People living in long-term care homes and their families/caregivers will participate in shared decision making to establish and monitor goals of care with respect to medication use considering effectiveness, safety and non-drug alternatives.

To support this behaviour, stakeholders identified the need for resources to inform people living in LTC and their care providers about the importance of their contributions to shared decision-making in medication management. We’re looking for your feedback about whether the following tools will help:

  • Shared Decision-Making in Medication Management Process Guide – Provide feedback here
  • Shared Decision-Making in Medication Management Infographic – Provide feedback here
  • Proposed Statement for Admission and Care Conference Checklists – Provide feedback here

Target behaviour: All health care providers and personnel will observe for signs and symptoms in the people they care for, reporting changes as a result of medication adjustments, or changes that might prompt review for deprescribing.

To support this behaviour, stakeholders identified the need for resources to inform family members and care providers (including personal support workers) to help them link signs and symptoms to medication-related effects. We’re looking for your feedback about whether the following tool will help :

For a summary report of this work and a full list of proposed behaviour changes and supporting actions, click here.