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Figuring out initial indication for which the med was started.... not being able to easily communicate with the prescribing provider

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Figuring out initial indication for which the med was started.... not being able to easily communicate with the prescribing provider

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multiple prescribers making it difficult to determine what each med is used for

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Build it into conversations with parents and patients.
Consider systems to encourage those conversations, consider associating diagnoses at med rec.

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Have a standardized way to address patients' medication lists, including frequency and provider responsible for doing so.

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Most children i know have more than one medical condition that requires different meds for treatment

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Most children i know have more than one medical condition that requires different meds for treatment

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keeping track of times of day, keeping track of most recent dose

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keeping track of routine follow up needed for every medication such as labs or imaging. 

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keeping track of routine follow up needed for every medication such as labs or imaging. 

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we don't want to cause harm or discomfort

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common meds or 2 med combos that might be "low-hanging fruit" for de-prescribing

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keeping track of why med was started

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there are medications that are used to treat common complaints, and they're started "to see if it helps" and then there's an observed benefit, at least at first.
Also, many of the medications that are on med lists are thought of as low risk on their own (PPI, H2 receptor antagonists, laxatives, anti-sialorrhea meds, antihistamines, etc)

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Many of them have many providers, including their primary care provider and subspecialists, which can lead to a lot of different people prescribing and managing medications

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uncertainty of result of deprescribing

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Help parents understand the negative side effects more. Benefits vs long term harm

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medications without a clear indication or overlapping indication with another med

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they have multiple medical conditions

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many providers are involved in the child's care

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causing discomfort or harm

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to discuss the potential benefits longterm

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multiple care providers. attempts at symptom management. hospital stays!

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empower me to stop medications or build systems or cultures around discussing medications among a patient's many providers to allow me to stop a med with easier buy in from other providers.

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have a way to contact prescribing/managing providers

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family preferences

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There is a high burden on the family for managing the timing, doses, and management of multiple different medications

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have to restart a medication thus losing the trust of the family

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they trust previous providers who started the treatment, anxiety/ not wanting to rock the boat 

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they trust previous providers who started the treatment, anxiety/ not wanting to rock the boat 

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patient's condition worsening
parental frustration with being constantly asked to stop medications

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discuss how if successful care would be simplified

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trying to figure out who is the managing provider

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Many parents lack understanding of importance of meds long term. 

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Many parents lack understanding of importance of meds long term. 

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objective assessment of effectiveness is difficult or may require unnecessary diagnostics, including invasive procedures

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a family is doing their best, and relying on this advice to keep their child at their best

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it is easier to "try something". Often times there is not a clear expectation of what success of a medication trial would look like so it just stays on. Occasionally it a short term med may get left on after a hospitalization

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Conversations with the patient's family and subspecialty provider if appropriate

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evidence based nuance to drug interactions, better interaction alerts
parent education about the benefit of deprescribing

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clear discussions at the start of a new med about what success looks like and expecations that we would stop the med if it does not meet that goal (or stops meeting the goal in the future)

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suggests lots of providers as well

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parents thinking they really depend on the medication

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for some families keeping up with times. our transplant team made this incredibly easy with a heart chart. fantastic solution to this issue

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for some families keeping up with times. our transplant team made this incredibly easy with a heart chart. fantastic solution to this issue