The information below outlines how health care professionals can be best served by the recommendations provided in this implementation guide.
| Key Points |
|---|
| Review recommendations with interdisciplinary team, solicit leadership support |
| Consider a stepwise, resident-centered approach for implementing recommendations |
| Adjust and individualize recommendations for specific resident clinical situations and local circumstances |
| For some medications, temporary discontinuation (a “pause”) may be advisable. In these cases, a process needs to be established for potential future resumption |
| Attention to potential harms and communication among providers, residents, and families and care partners is essential |
- Members of the interdisciplinary team should review the recommendations in this guide and determine which recommendations could be applied for their residents. Leadership support to guide and facilitate implementation is important, as is attention to workflow.
- Consider a stepwise, resident-centered approach for implementing recommendations in your facility. A suggested framework for implementing changes is:
- Step 1: Changes that are essential for infection control
- Step 2: Changes that are generally low risk, can be quickly evaluated for individual appropriateness, and can be done immediately
- Step 3: Changes that are generally low risk but may take more time for person-centered evaluation and communication, implementation, and monitoring
- Future Steps: There are additional types of medication optimization that are not addressed here because they may be better suited to a longer-term approach. This includes medication changes that often require slow medication tapers and/or close monitoring for withdrawal effects (e.g., psychotropics, dementia medications, certain blood pressure medications).
- Recommendations are advisory. They should be adapted to local circumstances (e.g., facilities’ current and future risk of COVID-19) and individualized for residents’ clinical situations and person-centered goals of care. Suggestions in this guide should not substitute for clinical judgment.
- Temporary discontinuations may be appropriate when the medication serves a useful therapeutic purpose but complicates medication administration at a time when streamlining administration can help address threats posed by COVID-19. Medications listed for temporary discontinuation in the tables are generally safe to be stopped for a period of several weeks or months.
- It is essential to keep track of medications whose discontinuation is intended to be temporary and to have a system for re-evaluating need for these medications at the appropriate time and re-introducing them if still indicated.
- Medications whose near-term use is essential for health should not be stopped.
- It is essential to keep track of medications whose discontinuation is intended to be temporary and to have a system for re-evaluating need for these medications at the appropriate time and re-introducing them if still indicated.
- Close attention should be paid to potential unintended consequences from medication changes. For example, this may include worsening of symptoms or increased social isolation from fewer resident contacts with staff. In addition, communication among the care team, residents, and families and care partners is essential prior to implementing recommendations. This can help identify and avoid potential areas of confusion, misinterpretation, or conflict.