The Society of Hospital Pharmacists of Australia
Recommendations from The Society of Hospital Pharmacists of Australia on end-of-life care, antibiotics, antipsychotic drugs, NSAIDs & codeine. The Society of Hospital Pharmacists of Australia (SHPA) is the national professional organisation for more than 3,000 pharmacists, pharmacists in training, pharmacy technicians and associates working across Australia’s health system.
1.
Don’t initiate and continue medicines for primary prevention in individuals who have a limited life expectancy.
Frail, elderly patients are more susceptible to the adverse effects of medicines. There is limited evidence to support the use of many medicines in elderly patients as they are typically excluded from clinical trials. One study has estimated the cost to the PBS of potentially inappropriate medication in older patients is between $240 and $450 million each year.
The use of medicines used to prevent a condition, or disease, or those with a long ‘time to benefit’ profile may not be consistent with the life expectancy of the patient and their goals of care.
The proactive de-prescribing of medicines that no longer provide a benefit to the patient is integral to end-of-life care and advance care planning. Patients or their carer, or designated guardian, should be involved in the decision to review treatment and the ongoing need for each medicine.
Supporting evidence
- Hardy JE, Hilmer SN. Deprescribing in the last year of life. J Pharm Pract Res 2011; 41(2):146-51.
- Elliott RA, Stehlik P. Identifying inappropriate prescribing for older people. J Pharm Pract Res 2013;43(4):312-9.
- Scott IA, Le Couteur DG. Physicians need to take the lead in deprescribing. Intern Med J 2015;45(3):352-6.
- Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D et al. Reducing inappropriate polypharmacy. JAMA Internal Medicine 2015;175(5):827-34.
How this list was made
A working party was formed and they sought suggestions from SHPA’s Committees of Specialty Practice, Reference Groups, State and Territory branches and Federal Council. More than 40 proposed statements were considered by the working party. A shortlist of 10 statements was identified for consideration by the SHPA’s membership through an online survey. All members were invited to comment on each proposed statement, specifically: whether it related to the practice of pharmacy, related to medicines that are frequently used, and if a significant cost. Members were also invited to rate the statements in order of preference. The survey results were used by the working party to identify the final six statements which were presented to SHPA’s Federal Council who ratified the choice of the five final statements.
- 1 Don’t initiate and continue medicines for primary prevention in individuals who have a limited life expectancy.
- 2 Don’t initiate an antibiotic without an identified indication and a predetermined length of treatment or review date.
- 3 Don’t initiate and continue antipsychotic medicines for behavioural and psychological symptoms of dementia for more than 3 months.
- 4 Don’t recommend the regular use of oral non-steroidal anti-inflammatory medicines (NSAIDs) in older people.
- 5 Don't recommend the use of medicines with sub-therapeutic doses of codeine (<30mg for adults) for mild to moderate pain.