Virtual Session Prompts 12/01/2020 by Abigail Hardin https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp POLYPHARMACY is when an individual taking 5 or more medications at one time. DEPRESCRIBING is the process of tapering, discontinuing, or withdrawing medications that may be causing harm or no longer be beneficial. en-us 2020-12-01 16:59:31 UTC 2020-12-01 18:36:25 UTC hello@padlet.com Accurately identifying the current efficacy of that particular medication in combination with the other medications to allow deprescribing. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976934490 2020-12-01 18:19:13 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976934490 Contacting the specialist or specialists who may have input regarding that medication https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976936232 2020-12-01 18:19:33 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976936232 concern that we won't be able to tell if 'worsening' is due to withdrawal of the medication vs typical fluctuation/progression of disease process. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976937321 2020-12-01 18:19:47 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976937321 https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976937723 If I did not prescribe the medication , then reaching out to prrescribing provider to discuss concerns can be a prolonged process and somewhat of a barrier

]]> 2020-12-01 18:19:52 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976937723 Not always being sure that I am aware of all of the medications that a child is on https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976939175 2020-12-01 18:20:07 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976939175 by in from provider, family, and patient https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976940105 2020-12-01 18:20:18 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976940105 if possible, have a central prescriber (PCP or palliative) https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976940477 2020-12-01 18:20:23 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976940477 you may not be the provider who is following up with the patient to identify effects of desprescribing https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976940742 2020-12-01 18:20:26 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976940742 Increased risk of side effects https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976941404 2020-12-01 18:20:34 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976941404 Their child's health is always tenious and deprescribing usually occurs when the child is at their baseline. Don't rock the boat. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976941572 2020-12-01 18:20:36 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976941572 they have multiple medical problems and/or previous medications have not achieved intended goals https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976942452 2020-12-01 18:20:45 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976942452 Obtaining an accurate medication list https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976942544 2020-12-01 18:20:46 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976942544 Contact/ input from all providers who may have input regarding that medication https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976942659 2020-12-01 18:20:48 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976942659 Fear that the targeted symptom or issue may worsen as the medication is decreased or discontinued https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976945609 2020-12-01 18:21:20 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976945609 patients can have multiple providers with input regarding various prescriptions https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976945640 2020-12-01 18:21:21 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976945640 every symptom or side effect is addressed with another medication (or so it seems) https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976945923 2020-12-01 18:21:24 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976945923 having to schedule life around medications as opposed to medications helping to enhance living. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976945964 2020-12-01 18:21:24 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976945964 you never really know if the medication is really not working or just not working well enough https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976946466 2020-12-01 18:21:31 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976946466 https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976946657 Testing may be needed]]> 2020-12-01 18:21:33 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976946657 All providers with organ systems or symptoms that may be impacted by deprescribing. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976947642 2020-12-01 18:21:43 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976947642 concerns regarding withdrawal https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976949261 2020-12-01 18:22:00 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976949261 understanding all potential interactions between medications https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976949624 2020-12-01 18:22:04 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976949624 they don't want symptoms to flare or conditions to get worse. They don't want to harm the patient https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976949784 2020-12-01 18:22:06 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976949784 things are going well/may get even worse if I take something off. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976950029 2020-12-01 18:22:09 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976950029 offer to take over the prescription https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976950359 2020-12-01 18:22:13 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976950359 Tracking the primary subspecialist responsible for prescribing a medication, even when it is overwritten by a resident during an acute hospitalization. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976950496 2020-12-01 18:22:14 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976950496 distinguishing which side effects are attributed to each medication https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976951148 2020-12-01 18:22:21 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976951148 https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976953101 Needing prior auths and that can lead to delay in medication refills.]]> 2020-12-01 18:22:43 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976953101 worsening symptoms leading to hospitalization https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976953554 2020-12-01 18:22:48 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976953554 increased risk of interactions and potentially needing frequent monitoring https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976953903 2020-12-01 18:22:52 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976953903 a single provider that has regular check-ins with the patient ultimately driving the taper https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976955015 2020-12-01 18:23:05 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976955015 they want to keep medications as is if the patient is stable https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976955164 2020-12-01 18:23:06 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976955164 honest and openly. Let me know before changes are made https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976955394 2020-12-01 18:23:09 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976955394 https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976955470 Dealing with multiple pharmacies for specialty meds.]]> 2020-12-01 18:23:10 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976955470 Find a mechanism for contacting all providers involved in the child's care. Most providers/ specialties are responsive to PPL or e-mail. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976956000 2020-12-01 18:23:16 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976956000 Unrecognized pain or discomfort in a nonverbal patient. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976956087 2020-12-01 18:23:17 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976956087 we always want patients and families to have a better QOL. We want less symptoms https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976957328 2020-12-01 18:23:31 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976957328 parents dont have "extra tools" to manage flareups, etc--better to leave some meds PRN https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976957445 2020-12-01 18:23:32 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976957445 regular review of all medications https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976958117 2020-12-01 18:23:40 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976958117 https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976958220 Condition may worsen.]]> 2020-12-01 18:23:42 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976958220 Another source of potential harm in a child already at risk for complications from their underlying diagnosis. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976959782 2020-12-01 18:24:01 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976959782 always trying to figure out which one is helping/hurting at this time https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976959833 2020-12-01 18:24:01 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976959833 Most have multiple specialists and may not have a provider willing to be a "quarterback" https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976960202 2020-12-01 18:24:06 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976960202 not start it https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976960989 2020-12-01 18:24:14 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976960989 there are too many services all writing their own medication rx involved in the management of medically complex children. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976961927 2020-12-01 18:24:25 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976961927 E-mail or phone call, but be sure that I have communicated back and don't assume that I am simply ignoring you https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976963355 2020-12-01 18:24:38 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976963355 risk of symptom rebound leading to morbidity https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976964296 2020-12-01 18:24:49 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976964296 Automatic refills, multiple subspecialties with various and sometimes juxtaposed goals https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976964961 2020-12-01 18:24:57 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976964961 I honestly can't think of one. I believe that less is more. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976966303 2020-12-01 18:25:12 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976966303 any form of communication would be better than no communication! https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976967585 2020-12-01 18:25:24 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976967585 you take away something that was actually making a difference leading to an adverse outcome. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976968161 2020-12-01 18:25:30 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976968161 Sometimes it is impossible to know how the child will respond because either the meds don't work in a typical fashion due to the diagnosis or there may be other unexpected symptoms or consequences that a given med are affecting without that being typical https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976968977 2020-12-01 18:25:40 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976968977 https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976969248 Meds have to be spaced and given many times a day.]]> 2020-12-01 18:25:42 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976969248 Ask if we could look at the current medication list to see if there are unnecessary or redundant medications that could be removed. Including topicals. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976969845 2020-12-01 18:25:49 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976969845 hvpqypnmxi https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976970531 Withdrawal side effects. Being able to restart medication in a timely manner if needed. Getting insurance to agree to pay for medication again if there were challenges initially getting the medication approved.  ]]> 2020-12-01 18:25:57 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976970531 accurately reflecting titration plans, sick day plans, etc--can not always put on the Rx itself https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976971622 2020-12-01 18:26:08 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976971622 simply ask if we could work together to optimize the medication regimen. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976972518 2020-12-01 18:26:19 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976972518 care conferences 1-2x yearly where all providers can discuss need for medications and be on the same page https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976973986 2020-12-01 18:26:34 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976973986 This patient population has multiorgan dysfunction and the mechanism for management in most cases is medication. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976974735 2020-12-01 18:26:43 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976974735 hvpqypnmxi https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976975587 Pharmacy availability. Insurance approval. Copay. Out of pocket expenses. Timing of medications. ]]> 2020-12-01 18:26:53 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976975587 too many referrals to specialists. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976975764 2020-12-01 18:26:55 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976975764 determining what symptoms are side effects, which are new symptoms, and which are part of the already known diagnoses https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976975938 2020-12-01 18:26:57 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976975938 https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976976456 A discussion in person during clinic visit]]> 2020-12-01 18:27:02 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976976456 parents/providers aren't patient enough; 1 bad day = we can't taper https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976977150 2020-12-01 18:27:10 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976977150 in children with medical complexity have a primary care physician or palliative care take responsibility for prescribing, as appropriate - reach out for management opinions/consultation from specialists. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976978676 2020-12-01 18:27:28 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976978676 Work at providing objective measures for therapeutic benefits for each medication, with appropriate evaluation for medication failure and discontinuation or titration. https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976981615 2020-12-01 18:28:01 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976981615 https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976985779 They see many specialists.  ]]> 2020-12-01 18:28:50 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976985779 a good pre and post record of symptoms, expected effects https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976987344 2020-12-01 18:29:08 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976987344 hvpqypnmxi https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976990016 If something is working, you don’t want to take it away. Change is difficult and sometimes it’s best not to rock the boat. Especially if there aren’t known side effects with the medication. ]]> 2020-12-01 18:29:39 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976990016 different teams trying to manage the same problem (pmr, pain, neuro all trying to do the same thing) https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976993190 2020-12-01 18:30:18 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/976993190 hvpqypnmxi https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/977002864 A conversation with the patient/caregiver. A care conference with the team would also be helpful. ]]> 2020-12-01 18:32:09 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/977002864 hvpqypnmxi https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/977010692 They need a little help. It’s not a bad thing but it’s important to be aware of all side effects. ]]> 2020-12-01 18:33:39 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/977010692 hvpqypnmxi https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/977013963 The patient could decline. ]]> 2020-12-01 18:34:15 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/977013963 hvpqypnmxi https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/977016163 Have a conversation. ]]> 2020-12-01 18:34:39 UTC https://padlet.com/hardinabigail10/mtvdsh64vnmeruqp/wish/977016163