Aim To develop a screening tool for prescribers to aid desprescribing on discharge from paediatric intensive care (PICU). Deprescribing is defined as ‘the process of withdrawal of an inappropriate medication supervised by a healthcare professional with the goal of managing polypharmacy and improving outcomes’.1 On the subject of deprescribing in paediatrics there is currently a lack of published literature however it is thought that we will be able to rationalise medicine use by being able to identify and document their indications.2
Method An audit was completed of twenty-five paediatric patients following discharge from PICU. Data was collected on which medicines were not appropriately stopped by PICU prescribers when patients were stepped down to the ward. These medicines were categorised by their indication and this information was used to create a deprescribing screening tool. Prescribers on PICU were educated on this new tool and a further audit is currently underway to assess the impact of this.
Results Twenty-five children were discharged from PICU to wards within the hospital over a four week period. Of these all twenty-five had two medicines or more that should have been deprescribed or a plan documented for before stepping down. A total of 110 medicines could have been deprescribed (median 4 per patient, range 2–8). These medicines were categorised by their indication: sedation 38.2% (n=42), electrolytes 33.6% (n=37), additional charts 18.2% (n=20), gastro-protection 4.5% (n=5), antibiotics 2.7% (n=3), other 2.7% (n=3).
We found that these medicines included high risk critical care only medicines that were unsafe to be administered on a ward such as high strength potassium infusions or inotropes, oral and IV sedative agents and antibiotics with no documented plan. Based on this information the following ‘CEASE’ screening tool was created:
Charts - are additional charts still in use and appropriate?
Electrolytes - have all PICU only electrolytes been stopped?
Antibiotics - do all antibiotics have a documented plan?
Sedation - has all sedation been stopped or if not is there a documented plan of when and how to stop?
Enteral - if enteral feeds have started has all gastro-protection been stopped?
A further audit is currently underway to assess the impact of the ‘CEASE’ tool.
Conclusion The audit has shown that a range of different medicines were inappropriately continued outside of PICU, this includes high risk medicines not suitable for use on the ward. The development of the ‘CEASE’ tool has been created to aid prescribers in the identification of medicines which should be deprescribed. This should help to provide better treatment, improve patient safety and promote antimicrobial stewardship.
Reeve E, Gnjidic D, et al. A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol 2015;80:1254–68.
Begum R, Tomlin S. Deprescribing in paediatrics. Eur J Hosp Pharm 2017;24:70.
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