Addressing Anticholinergic Burden in Assisted Living Residents Through Scoring and Deprescribing

Abstract

Problem: Anticholinergic (ACH) burden results when there is concurrent use of multiple medications with anticholinergic properties. At an assisted living facility for older adults, at least 50% of the residents there have dementia and at least 25% have behavioral symptoms that often require pharmacological intervention with ACH psychotropic medication. Approximately 75% of those residents take at least one ACH medication daily. Purpose: The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of an anticholinergic burden quantifying tool for use by prescribers and medication administration staff. It was anticipated that the residents would benefit from assessment of medications with ACH effects through provider and staff use of the tool. Methods: Pre-implementation, retrospective chart audits were done to assess ACH use at baseline. Staff were trained on use of the Anticholinergic Burden (ACB) Scale to identify medications with anticholinergic properties. The residents’ medication administration record (MAR) was assessed weekly for new medication orders, then evaluated for anticholinergic scoring according to the ACB Scale. Providers viewed the residents’ ACH scoring sheets and determined whether current medications could be deprescribed or have gradual dosage reductions. Results: Project results revealed, out of a total of 27 residents, three residents had medication adjustments. Two of the three residents had dosage reductions of anticholinergic medication and two of those three had anticholinergic medications deprescribed. Conclusions: The findings suggest that use of a tool to identify and score medications with anticholinergic properties is necessary to increase awareness among providers and medication administration staff. This simple approach can serve as an ideal method for promoting safety for residents of assisted living facilities.