CP-003 ‘Deprescribing psychoactive for geriatric patients in a multidisciplinary way’ S. Desmet, D. Kindt, A. Verhaeghe, K. Verhelle, Clinical pharmacy department AZ Groeninge, Kortrijk, Belgium

1. BACKGROUND 3. METHOD A lot of studies emphasize the incidence of serious harms caused by Period: during 5 weeks patients were screened. polymedication in elderly patients. Especially the use of INCLUSION criteria: patient over 75 years with at least one other and/or combination with other psychoactive criterium: medication increase the risk for , falls, cognitive - a contra-indication for benzodiazepines impairment, and other adverse drug events. - use of a equivalent of at least 20mg (calculated via 2. OBJECTIVE http://benzoschema.knmp.nl/benzos_enduser_pt), Guarding the safety and quality of life for geriatric patients with - pharmacodynamic synergistic interaction (, polymedication by reducing the use of psychoactive medication in a , , antihistaminics and multidisciplinary way with the clinical pharmacist, geriatrician, ) general practitioner and home pharmacist. EXCLUSION criteria: palliative patients, exclusion by the geriatrician.

4. RESULTS A) WORKFLOW AND TOOLS 1. Workflow of the clinical 2. Contra-indications 4. Reduction schedules pharmacist Reduction schedules for anti- Other long acting benzodiazepines can be COPD and antipsychotics can be found on: swtiched to diazepam in order to reduce in Identify patients at risk (inclusion Asthma http://wiki.psychiatrienet.nl/index.php/ small steps. criteria) by checking their home medication Short and intermediate acting Long acting (e.g. , benzodiazepines can be reduced in steps Clorazepaat, , , corresponding to half of the lowest ) 3. Diazepam equivalent commercially available dose. Inform patients about the step 1 10-20% reduction every 2 weeks to

impact of benzodiazepines and Molecule dose (mg) 2mg achieve an equivalent dose of 20mg propose to reduce equivalent to 2 weeks 1,5mg diazepam 10mg 2 weeks 1mg step 2 Switch to 20mg diazepam diazepam Consult the geriatrician to decide 2 weeks 0,5mg step 3 15mg diazepam 0,5 2 weeks 0,5mg every other day which psychoactive medication step 4 10mg diazepam 1 to reduce stop 10 step 5 8mg diazepam This can also be used for long acting Brotiazolam 0,25 benzodiazepines with low commercially step 6 6mg diazepam Contact the general practitioner 5 available doses step 7 4mg diazepam for agreement on the reduction 2 2x 1mg a day step 8 2,5mg diazepam schedule Lormetazepam 1 2 weeks 0,5mg – 1 mg step 9 2mg diazepam 2 step 10 2mg diazepam every other day Cloxazolam 1 2 weeks 1mg in the evening With permission of the patient: step 11 stop Ethylloflazepate 2 2 weeks 0,5mg in the evening inform the home pharmacist Nordazepam 5 stop about the reduction schedule 10

B) 5 WEEK TEST Patients informed by the clinical pharmacist (n=20) NOT MOTIVATED 30 patients met the inclusion criteria. 6 were not approachable, for 4 patients the psychoactive medication was already stopped in the hospital. 70% of the patients informed agreed to reduce their 10% EXCLUSION BY psychoactive medication. 10% was excluded by the geriatrician, for 15% 15% reduction was suggested via the discharge letter. The general Not GERIATRICIAN Motivated 45% practitioner always supported the effectuation of the reduction. motivated 70% This project resulted in the development of a multidisciplinary 30% REDUCTION SUGGESTED workflow and some practical tools that can be used by any doctor or IN DISCHARGE LETTER pharmacist. REDUCTION SCHEDULE CONCLUSION MADE  Deprescribing psychoactive medication for elderly people can successfully be implemented by the development of a multidisciplinary workflow (clinical pharmacist – specialist - general practitioner - home pharmacist) and by providing some practical tools.  Our goal of patient safety could be achieved and led to satisfaction of patients and caregivers.

References: • www.bcfi.be • http://www.gezondheid.belgie.be/benzo