Determined to Deprescribe

A U OF M ALUMNA with a strong commitment to health-care improvement is making an impact by promoting the deprescribing of inappropriate medications in nursing homes.

As the personal care home pharmacy manager with the Winnipeg Regional Health Authority (WRHA) Long Term Care Program, Allison Bell [B.Sc.Pharm/03] oversees the delivery of pharmacy services to more than 8,000 residents at 103 nursing homes across the province.

Bell, who has been in the role for eight years, sets clinical policies, provides guidance to pharmacists, monitors drug costs and strives to optimize residents’ medications.

One of her priorities is deprescribing – the supervised process of reducing or eliminating a medication to improve a person’s health or reduce the risk of adverse side effects.

“I’m passionate about deprescribing because it’s part of the solution to older adults taking too many medications, or risky medications,” says Bell, who is a member of the Canadian Deprescribing Network, a group working to raise awareness and eliminate the use of potentially inappropriate medications for seniors.

“Deprescribing can help optimize medications and improve quality of life. With the medication knowledge that pharmacists have, they are ideal deprescribing champions.”

In 2013-14, Bell completed a fellowship with the Canadian Foundation for Healthcare Improvement. As part of her learning, she teamed with WRHA colleagues for a project that aimed to reduce the use of antipsychotic drugs among nursing home residents who had not been diagnosed with psychosis.

Antipsychotic medications are often prescribed to manage behaviour in people with dementia, Bell says. But they can increase the risk of stroke, falls, hip fractures and mortality, and reduce quality of life.

The project involved interprofessional teams at three personal care homes. The pharmacist noted which residents’ prescriptions should be reassessed. The prescribing doctor received the latest evidence-based recommendations on antipsychotics before medication reviews. Nurses, support staff and families received dementia care training in how to respond to behaviours without reliance on medication.

“The project was even more successful than we hoped,” Bell says. Health-care teams reduced or stopped antipsychotic medications in 56 per cent of 115 residents, many of whom had dementia. Overall, gains were seen in cognitive performance, social engagement and activities of daily living.

“With most residents, there was no change in behaviour when the medication was tapered or discontinued, which shows that they were not benefiting from it and were at risk of side effects if they kept taking it,” Bell says.

The lessons learned were then scaled up to personal care homes across Winnipeg. Back in 2010-11, 29 per cent of WRHA long-term care residents without a diagnosis of psychosis were on antipsychotic drugs. Seven years later, the number was down to less than 20 per cent.

Bell and her colleagues now choose a different deprescribing focus each quarter for residents’ medication reviews. Recently, they’ve looked at diabetes medications, vitamin and mineral supplements, sedatives for insomnia and proton pump inhibitors for stomach acid.

Bell, who was raised in Selkirk, Man., completed a bachelor of science at the University of Winnipeg in 1999. She earned her bachelor of science in pharmacy at the U of M in 2003, graduating with the gold medal. Prior to her current role, she worked as a hospital pharmacist and with the Community Intravenous Program.

She is now seeking ways to become a more effective health-care leader. “I have a deep interest in continued development,” she says.

In 2016-17, she took part in the George & Fay Yee Centre for Healthcare Innovation’s academic health sciences leadership program. She is currently enrolled in the master of health management program at McMaster University.

Bell credits the U of M with helping to develop her determination and inner drive. “To be successful in any health-care career, you really need to have a strong work ethic and be able to motivate yourself,” she says. “Those are skills I use daily in my career.”