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Deprescribing: A Consulting Pharmacy Approach

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In long-term care, more isn’t always better, especially when it comes to medication. Residents often arrive with a laundry list of prescriptions written by multiple providers across different care settings for conditions that may or may not still be clinically relevant. It’s not unusual to see ten, fifteen, even twenty medications on a single administration record.

But just because a medication was once appropriate doesn’t mean it still is. And the longer those outdated orders linger, the more likely they are to cause harm.

That’s where deprescribing comes in.

What Is Deprescribing and Why Does It Matter?

Deprescribing is the intentional, supervised process of reducing or discontinuing medications that are no longer needed, effective, or safe. It’s not about denying care—it’s about aligning therapy with the resident’s current condition, goals, and risk profile.

In long-term care, deprescribing isn’t just a best practice. It’s often a necessary one. Residents are more vulnerable to side effects, drug interactions, and medication-related functional decline. Many are living with cognitive impairment, impaired mobility, or multiple chronic illnesses, all of which change how medications should be prescribed and monitored.

Polypharmacy can quickly lead to:

  • Increased risk of falls, confusion, and sedation
  • Diminished appetite or gastrointestinal issues
  • Difficulty managing adherence during care transitions
  • Decreased quality of life due to side effects or pill burden

Deprescribing reduces those risks and helps restore clarity to care plans that have grown cluttered over time.

How a Consulting Pharmacy Facilitates Deprescribing

Deprescribing isn’t as simple as crossing meds off a list. It requires clinical judgment, coordination, and clear communication among the care team. That’s where a consulting pharmacy can make all the difference.

A licensed consulting pharmacist brings an outside clinical perspective, unclouded by routine. They aren’t part of the daily med pass, so they’re better positioned to ask hard questions: Is this medication still needed? Has the risk profile changed? What’s the original indication, and does it still apply?

As part of routine medication regimen reviews, the pharmacist evaluates every active order for opportunities to taper, discontinue, or substitute safer alternatives. They identify redundancies, flag high-risk meds, and help the care team understand what can safely be adjusted.

Common deprescribing targets in LTC include:

  • Antipsychotics used off-label
  • Benzodiazepines and other sedative-hypnotics
  • Proton pump inhibitors (PPIs) without a clear indication
  • Anticholinergics linked to cognitive decline
  • PRNs that have become unnecessary standing orders
  • Duplicate therapies within the same drug class

These aren’t small tweaks. They’re changes that can dramatically reduce resident risk—and help staff deliver safer, more focused care.

Deprescribing Is a Team Effort

The pharmacist doesn’t act alone. Once a target is identified, the deprescribing process involves coordination with the attending physician, the nursing team, and often the resident or family. Success depends on shared understanding and thoughtful timing.

Some medications, especially those affecting mood, sleep, or cognition, require tapering plans to avoid withdrawal effects or symptom rebound. The pharmacist develops a plan based on current guidelines and collaborates with nursing staff to monitor for changes in condition or behavior during the taper.

In other cases, the process is more straightforward. A PPI added during a hospital stay might be safely discontinued. A nightly sedative prescribed two years ago may no longer serve a clear purpose. In either case, documentation is key. The consulting pharmacist ensures recommendations are properly recorded and followed up in subsequent reviews.

Regulatory Benefits of a Deprescribing Strategy

CMS doesn’t just allow deprescribing—it expects it. F757 and F758 specifically require facilities to minimize unnecessary medications and regularly attempt gradual dose reductions for certain drug classes, especially psychotropics.

Surveyors want to see evidence that the facility is actively managing its medication burden. That means:

  • Regular documentation of medication review findings
  • Clear rationale for continuing high-risk or long-term meds
  • Written gradual dose reduction (GDR) attempts and outcomes
  • Engagement of the care team in medication decision-making

Deprescribing, supported by consulting pharmacy oversight, checks all of those boxes. It provides a paper trail of proactive risk reduction and puts the facility on stronger footing during surveys.

Improved Outcomes for Residents and Facilities

The benefits of deprescribing go beyond regulatory compliance. For residents, fewer medications can mean more energy, better sleep, improved cognition, and fewer trips to the hospital. For facilities, it can reduce fall rates, adverse drug events, and the sheer burden of daily med administration.

It also supports quality improvement initiatives tied to:

  • Antipsychotic use reduction
  • Fall prevention
  • Pain and sedation management
  • Rehospitalization reduction
  • Resident satisfaction and engagement

In a value-based care environment, those improvements matter. Facilities that manage medications more thoughtfully perform better on quality metrics, survey results, and resident outcomes.

Deprescribing Requires Expertise, Not Guesswork

One of the biggest misconceptions about deprescribing is that it’s reactive—something you only do when a resident starts declining. In reality, the most effective deprescribing is proactive. It’s built into monthly reviews. It’s discussed in care plan meetings. It’s triggered by changes in condition or goals of care. And it’s led by someone who understands the clinical, operational, and regulatory landscape.

Consulting pharmacists are uniquely equipped to lead that process. They’re trained in pharmacokinetics, geriatric medicine, and regulatory compliance. They see the big picture but know how to drill down to specific risk factors. And most importantly, they work with your team to make deprescribing a smooth, collaborative process—not a disruptive one.

A Smarter Way to Manage Medications

Medication therapy should be deliberate, dynamic, and constantly evaluated. When regimens grow stale or overloaded, residents suffer—and so does the quality of care. Deprescribing is one of the clearest ways to reduce harm, restore function, and create a care environment that prioritizes what truly benefits the resident.

It’s not about doing less. It’s about doing what’s right.

Deprescribe Safely and Confidently With Angus Lake

Simplify medication regimens and strengthen your care strategy. Angus Lake Healthcare offers expert deprescribing support through pharmacist-led consulting. Call today to learn more: (478) 233-1828

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