# Why Less is More: Strategies for Deprescribing in the ED About This Podcast With the upcoming implementation of the new CMS age-friendly hospital measure, hospitals will be required to attest that they review medications to identify potentially inappropriate medications (PIMS) for older adults. . Dr. Martin Casey, MD, MPH is an Assistant Professor in the Department of Emergency Medicine at UNC School of Medicine. Dr. Casey's work has focused on the identifying PIMS and finding opportunities to reduce the use of, and deprescribe, potentially harmful medications in the emergency department. In this episode, Dr. Christina Shenvi and Dr. Martin Casey will discuss strategies for ED physicians who face unique challenges when assessing older patients’ medications. Using case examples of deprescribing in practice, they illustrate how deprescribing is a nuanced skill and how to approach it. Play the Episode https://youtu.be/c_R-69t37gk Subscribe on YouTube Subscribe on iTunes Key Points Deprescribing is an individualized process and there are various methods that should be considered. Following identification of PIMs, a physician may consider dose reduction or adjustment, switching to alternative medications, and/or discontinuing the PIM. It is important to include patient education to raise awareness of potential adverse effects is key. Assessment of medications should occur at various critical moments, including before admission, prior to procedures and in the event of significant changes in a patients’ clinical status. Emergency Department physicians often lack key patient information that is crucial when considering deprescribing. Collaboration with primary care physicians is valuable throughout the process of deprescribing. Diagnosing adverse drug events (ADEs) is essential; physicians should explicitly communicate issues with problematic medications to both patients and outpatient prescribers through systems. While current deprescribing guidelines vary depending on the medication being considered, further guidelines are expected as the CMS age-friendly hospital measure is implemented. For example, aspirin in the absence of identifiable cardiovascular disease has clear guidelines for deprescribing. Medications used for symptom management (eg. opioids, benzodiazepines, gabapentin) can be more complex as the removal of these medications can potentially lead to adverse events. Related & Mentioned Resources Below are some resources which you may find useful for deprescribing. WEBINAR | November 18, 2024 What Matters in the ED: Addressing goals of care and meeting CMS Age-Friendly Hospital Measure in the Geriatric Emergency Department Experts in geriatric emergency medicine discuss the new CMS age-friendly hospital measure and how hospitals nation wide can meet the measure through GEDC resources and GEDA accreditation. Watch Webinar BLOG | August 28, 2024 CMS Age Friendly Hospital Measure: Resources for Emergency Departments Helpful educational resources to help you and your emergency department meet the CMS Age-Friendly Hospital measure. Explore Resource deprescribing.org Deprescribing research and guidelines support healthcare providers and patients in reducing or stopping medications that may be harmful or no longer needed. Visit Website US Deprescribing Research Network The goal of the US Deprescribing Research Network (USDeN) is to develop and disseminate evidence about deprescribing for older adults, and in doing so to help improve medication use among older adults and the outcomes that are important to them. Visit Website Next, listen to Creating a Generational Health Program with Dr. Diane Wintz, Dr. Stacy Nilsen and Kelly Wright. Play Episode View All Medication Management Resources >