VUMC’s Shed-MEDS protocol reduces exposure to potentially inappropriate medications

An estimated one in six older adults in the United States who take multiple prescription drugs risk major drug-drug interactions and other adverse drug effects that can worsen their medical conditions, increase the likelihood of cognitive impairment and falls, and lead to hospitalization or death.

Deprescribing is a systematic effort to identify, reduce the dose or stop unnecessary or potentially inappropriate medications in a manner that is safe and effective. One approach is Sheds-MEDS, a hospital-based, pharmacist- or nurse practitioner-led, and patient-centered deprescribing protocol developed at Vanderbilt University Medical Center.

Reporting Feb. 6 in the journal JAMA Internal Medicine, Eduard Vasilevskis, MD, MPH, and colleagues found that implementing the Shed-MEDS protocol in the hospital prior to discharge to a post-acute care facility, such as a nursing/rehabilitation center, significantly reduced the number of medications patients received.

While the rates of adverse drug events were similar between patients randomly selected to receive the deprescribing intervention and a control group that did not, the reduced medication burden persisted for at least 90 days, and "the intervention additionally reduced exposure to potentially inappropriate medications," the researchers reported.

This study demonstrates that the hospital may be a safe and effective health care setting to help address the epidemic of polypharmacy often seen in older hospitalized adults."

Eduard Vasilevskis, Associate Professor of Medicine and Chief of the Section of Hospital Medicine

"Furthermore, post-acute care settings, such as skilled nursing facilities, may be valuable partners to continue safe deprescribing practices," he said.

Further research is necessary to determine the impact of deprescribing on long-term clinical outcomes, the researchers added.

Coauthors included the study's co-principal investigator, Sandra Simmons, PhD, professor of Medicine and Psychology and the Paul V. Hamilton, MD Chair in Geriatrics, and Amanda Mixon, MD, MPH, associate professor of Medicine and Biomedical Informatics.

Mixon and Simmons co-lead the Pilot and Exploratory Studies Core of the U.S. Deprescribing Research Network, an interdisciplinary community of physicians, pharmacists, nurses, older adults, and their care partners who are advancing deprescribing research with the support of the National Institute on Aging of the National Institutes of Health.

Other co-authors included Avantica Saraf Shah, MPH, Emily Kay Hollingsworth, MSW, Matthew Steven Shotwell, PhD, and Sunil Kripalani, MD, MSc.

The study was supported by NIA grant number AG053264.