The additional resources provided below serve as a supplement to this guide and include a dose conversion table, sample letters, and other useful resources.
- Downloadable Materials
- Dose Conversions When Transitioning from Shorter- to Longer-Acting Regimens or Less Frequent Dosing
- External Resources
- References
- Draft Letter to Prescribers
- Draft Letter to Residents and Care Partners
Downloadable Materials
Printer-friendly versions of this guide and its recommendations are available here:
Dose Conversions When Transitioning from Shorter- to Longer-Acting Regimens or Less Frequent Dosing
| Medication Conversion | Immediate-Release Dose | Equivalent Extended-Release Dose |
|---|---|---|
| Acetaminophen (Tylenol) four times daily to less frequent dosing or conversion to acetaminophen extended release (Tylenol ER) | 325 mg QID/q6h 500 mg QID/q6h 1000 mg QID/q6h |
→ Consider TID or BID dosing with IR or ER formulation, based on resident pain level |
| Metoprolol tartrate (twice daily) to metoprolol succinate (once daily) | 25 mg BID 50 mg BID 100 mg BID |
→ 50 mg daily (Succinate) → 100 mg daily (Succinate) → 200 mg daily (Succinate) |
| Carvedilol (twice daily) to carvedilol CR (once daily) | 3.125 mg BID 6.25 mg BID 12.5 mg BID 25 mg BID |
→ 10 mg daily (ER) → 20 mg daily (ER) → 40 mg daily (ER) → 80 mg daily (ER) |
| Metformin IR (twice daily) to metformin IR or ER (once daily) | 500 mg BID 750 mg BID 1000 mg BID |
→ 1000 mg (IR or ER)* daily → 750 mg (ER), 2 tabs once daily → 1000 mg (ER), 2 tabs once daily |
| Proton pump inhibitors twice daily to once daily | Full daily dose, e.g., omeprazole 20 mg BID | → Halve total daily dose, e.g., omeprazole 20 mg daily |
* For metformin, reasonable to give up to 1000 mg of immediate release (IR) formulation in a single dose. Gastrointestinal symptoms may limit the total dose that can be administered at one time. Be mindful of wide variability in pricing of Metformin extended release (ER) formulations.
* Long-acting medication formulations may be termed ER, CR, XL, or XR. We use the term ER (extended release) here to refer to all such formulations; no preference for a specific long-acting formulation is implied.
* References for conversions: LexiComp, deprescribing.org
External Resources
| Type of Material | Location |
|---|---|
| COVID-19 resource sites from: American Geriatrics Society (AGS) Society for Post-Acute and Long-Term Care (AMDA) American Society of Consultant Pharmacists |
https://www.americangeriatrics.org/covid19 https://paltc.org/covid-19 www.ascp.com/disaster |
| Evidence-based deprescribing guidelines Proton pump inhibitors Antihyperglycemics Antipsychotics Benzodiazepine receptor agonists Cholinesterase inhibitors and memantine |
https://deprescribing.org/resources/deprescribing-guidelines-algorithms/ |
| Resident/patient handouts about deprescribing | https://www.deprescribingnetwork.ca/patient-handouts |
References
Click here for a list of references that provide evidentiary support and background materials relevant to this Implementation Guide.
Draft Letter to Prescribers (On Facility Letterhead)
Download a customizable, printer-friendly version of the draft letter to prescribers here.
DATE
Dear (Prescriber/Clinician),
Thank you for being a critical member of our interprofessional team. As part of our efforts to address the COVID-19 pandemic, we have increased the frequency of our in-house monitoring of resident medication regimens. The purpose of this letter is to explain our recommended changes to your resident’s medication regimen and solicit your support.
In light of the threats posed by the pandemic, we have focused our review on several areas. One is to reduce medications that may no longer be necessary and to align the times that medications are given as much as possible. This can reduce burden on residents and minimize non-essential close contact between residents and staff, thereby reducing risks of disease transmission. It also allows our nurses to spend more time on other essential activities that support resident well-being. In addition, certain medications pose special risks during this period of COVID-19. This includes medications that require additional administration times as well as large, chalky pills which frequently cause residents to cough or require close physical contact from staff to help swallow. Even when appropriate for long-term use, medicines that can safely be stopped for weeks or months may be appropriate to temporarily hold during this period of high COVID-19 threats.
Our overriding goal is to protect the health and well-being of our residents. We are thus making medication recommendations that we believe will promote our residents’ health and safety in light of both their chronic conditions and threats posed by COVID-19. Our in-house team, with input from residents, direct care workers, and family members and care partners has identified the following residents with medication regimens that could be modified.
| Name | Current Medication Regimen | Recommended Changes | Rationale | Comments (alternatives recommended by PCP) |
|---|---|---|---|---|
Please contact Dr. X, Medical Director, at (email, phone) if you would like to discuss these changes. We would be glad to talk. If we do not hear back from you within [XX days/week(s)], we will make these changes.
Thank you very much for your care of residents in this community. We value your leadership and insights in promoting wellness, quality of care and quality of life.
Sincerely,
CMO
CNO
PharmD
Administrator
Draft Letter to Residents and Care Partners (On Facility Letterhead)
DATE
Dear (Resident and/or Care Partner),
During the COVID pandemic, we are working hard to ensure your safety. To reduce the potential for exposure to this disease, the clinical team is reviewing the way we currently provide medications across the facility. For some people, we may be able to change the times at which medications are administered. For others, we may reduce the number of medications when it is safe to do so. Residents may have their pulse or blood pressure checked less frequently when appropriate. We are carefully making individual decisions about each person with guidance from our full team.
Recently, our clinical team including nurses, pharmacists, and your primary care clinician reviewed your medical conditions and medications. We may be able to simplify your medications to reduce the risk of COVID-19 exposure, lessen side effects, and improve your overall health.
As we consider possible medication changes, we value each resident’s input about their own care. Our goal is to focus on what matters to YOU, and to work together to achieve those goals. Your care team plans to discuss possible medication changes with you (and if you would like, with your family member or care partner). We believe that this opportunity will improve safety, quality of care, and quality of life for you and other residents in our community.
If you would like to speak with the medical director or director of nursing about this directly, please contact (names here with emails and telephone numbers).
Thank you for being a critical member of our team. We value your input and ideas.
Sincerely,
CMO
CNO
PharmD
Administrator