The Nurse as Catalyst: Investigating and Expanding the Role of Nursing within a Deprescribing Model with Physicians and Pharmacists of General Medicine
DOI:
https://doi.org/10.64483/jmph-77Keywords:
Polypharmacy, Deprescribing, Nursing, Patient Safety, Interprofessional CollaborationAbstract
Background: Polypharmacy is widespread among older adults and individuals with chronic conditions and increases the risks of adverse drug events, hospitalizations, and mortality. Deprescribing, the systematic reduction of medications that are unnecessary or potentially inappropriate (PIMs), can help mitigate these risks. Although nurses are well-suited to do deprescribing because of frequent patient interactions and a holistic lens to the overall patient, the role of the nurse in deprescribing remains underexplored. Aim: The purpose of this review is to explore the role of nurses in deprescribing in general medicine and to examine their involvement along with physicians and pharmacists. The paper identifies barriers and facilitators to involvement and pathways forward. Methods: We conducted a narrative review focused on peer-reviewed studies from 2020-2024 using PubMed, CINAHL, Scopus, and Web of Science. We used variations of the search terms "deprescribing", "nursing," and "polypharmacy." The inclusion criteria were English-language, peer-reviewed studies that focused on nurse-led deprescribing within the general medicine scope. We extracted data on nurse role, patient outcomes, and barriers/facilitators relevant to the study, using inductive thematic analysis. Results: Nurses were found to contribute through patient assessment, education, advocacy, and interdisciplinary care, reducing PIMs by as much as 30% and ADEs by 20%. Barriers included a lack of authority and a lack of time, and factors that facilitated successful nursing involvement included previous training in deprescribing methodology and integration of the Educator role with Electronic Health Records (EHR) nursing documentation. Conclusion: Nurses must play a central role in the process of deprescribing (to improve patient safety). Policy changes, nurse education, and technology will assist in embedding the nursing profession into deprescribing initiatives. Future research must focus on the use of a diverse range of settings, with longer-term follow-up outcomes.
References
Abu Haddash, N. A. M. (2025). Therapeutic Potential of Plant-Based Dietary Interventions in Chronic Disease Remission: Mechanisms, Clinical Evidence, and Practical Implementation . Saudi Journal of Medicine and Public Health, 2(2), 53–61. https://doi.org/10.64483/jmph-32
Alharthi, M. S. (2025, May). Barriers and Facilitators to Proactive Deprescribing in Saudi Hospitals: A Qualitative Study Using the Theoretical Domains Framework. In Healthcare (Vol. 13, No. 11, p. 1274). MDPI. https://doi.org/10.3390/healthcare13111274
Alhabeeb, S., Almetrek , A. A., Al-Amri, M. I., Alajlan, A. A. A., Alfehaid , F. A. S., Alsaudi, Mohanad K. I., & Alsheeb, A. A. A. (2025). Pharmacological Role and Clinical Applications of 5α-Reductase Inhibitors-Review Article for Pharmacists and Healthcare Professionals. Saudi Journal of Medicine and Public Health, 2(2), 85–94. https://doi.org/10.64483/jmph-40
Bakr, F. anwr, ALSAHLI, S. S. M., Alruqi, A. F., Alfaqih, A. A. M., Abutalib, F. M., Alkhaytan, A. N., … ALANAZI, S. F. (2024). Management of Dental Anxiety, Nurse Intervention, and Support for Sedation: A Comprehensive Review. Saudi Journal of Medicine and Public Health, 1(1), 131–143. https://doi.org/10.64483/jmph-59
Berardinelli, D., Conti, A., Hasnaoui, A., Casabona, E., Martin, B., Campagna, S., & Dimonte, V. (2024, November). Nurse-led interventions for improving medication adherence in chronic diseases: A systematic review. In Healthcare (Vol. 12, No. 23, p. 2337). MDPI. https://doi.org/10.3390/healthcare12232337
Bužančić, I. (2024). Formative evaluation of the needs, opportunities, and barriers in the implementation of deprescribing in primary healthcare (Doctoral dissertation, University of Zagreb. Faculty of Pharmacy and Biochemistry. Centre for applied pharmacy). https://urn.nsk.hr/urn:nbn:hr:163:963229
Cernasev, A., Scott, D., Barenie, R., Walker, C., Khan, M., Koltnow, P., ... & Hall, A. (2024). “I think deprescribing is very needed in our society:” Healthcare Professional Students Perceptions of Deprescribing Education. Innovations in Pharmacy, 15(3), 10-24926. doi: 10.24926/iip.v15i3.5948
Choi, J. Y., Kim, H., Chun, S., Jung, Y. I., Yoo, S., Oh, I. H., ... & Kim, K. I. (2024). Information technology-supported integrated health service for older adults in long-term care settings. BMC medicine, 22(1), 212. https://doi.org/10.1186/s12916-024-03427-7
Chua, S., Todd, A., Reeve, E., Smith, S. M., Fox, J., Elsisi, Z., ... & Expert Panel. (2024). Deprescribing interventions in older adults: An overview of systematic reviews. Plos one, 19(6), e0305215. https://doi.org/10.1371/journal.pone.0305215
Clark, C. M., LaValley, S. A., Singh, R., Mustafa, E., Monte, S. V., & Wahler Jr, R. G. (2020). A pharmacist-led pilot program to facilitate deprescribing in a primary care clinic. Journal of the American Pharmacists Association, 60(1), 105-111. https://doi.org/10.1016/j.japh.2019.09.011
Evrard, P., Damiaens, A., Patey, A. M., Grimshaw, J. M., & Spinewine, A. (2023). Barriers and enablers towards benzodiazepine-receptor agonists deprescribing in nursing homes: A qualitative study of stakeholder groups. Exploratory research in clinical and social pharmacy, 9, 100258. https://doi.org/10.1016/j.rcsop.2023.100258
Farrell, B., Raman-Wilms, L., Sadowski, C. A., Mallery, L., Turner, J., Gagnon, C., ... & Upshur, R. (2023). A proposed curricular framework for an interprofessional approach to deprescribing. Medical science educator, 33(2), 551-567. https://doi.org/10.1007/s40670-022-01704-9
Forgerini, M., Schiavo, G., Camila-Lucchetta, R., & de Carvalho-Mastroianni, P. (2020). Drug interactions for elderly with respiratory disease and times of COVID-19: a systematic scoping review. Vitae, 27(3). https://doi.org/10.17533/udea.vitae.v27n3a02
Hodulik, A. (2024). Implementation of a Polypharmacy Deprescribing Protocol to Reduce Medication Burden in Older Adults Greater than 65 Years of Age in a Rehabilitation Center (Doctoral dissertation, Florida Gulf Coast University).
Jing, B., Liu, X., Graham, L. A., Dave, C. V., Li, Y., Fung, K., ... & Odden, M. C. (2024). Deprescribing of antihypertensive medications and cognitive function in nursing home residents. JAMA internal medicine, 184(11), 1347-1355. doi:10.1001/jamainternmed.2024.4851
Karrer, M., Hirt, J., Zeller, A., & Saxer, S. (2020). What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review. BMC geriatrics, 20(1), 127. https://doi.org/10.1186/s12877-020-01520-z
Kua, C. H., Yeo, C. Y. Y., Tan, P. C., Char, C. W. T., Tan, C. W. Y., Mak, V., ... & Lee, S. W. H. (2021). Association of deprescribing with reduction in mortality and hospitalization: a pragmatic stepped-wedge cluster-randomized controlled trial. Journal of the American Medical Directors Association, 22(1), 82-89. https://doi.org/10.1016/j.jamda.2020.03.012
McCann, C., McCauley, C. O., & Harkin, D. (2024). Barriers and facilitators to opioid deprescribing among advanced nurse practitioners: a qualitative interview study. Journal of Advanced Nursing, 80(6), 2500-2511. https://doi.org/10.1111/jan.15995
Naughton, C., & Hayes, N. (2017). Deprescribing in older adults: a new concept for nurses in administering medicines and as prescribers of medicine. European Journal of Hospital Pharmacy, 24(1), 47-50. https://doi.org/10.1136/ejhpharm-2016-000908
O’Mahony, D., Cherubini, A., Guiteras, A. R., Denkinger, M., Beuscart, J. B., Onder, G., ... & Curtin, D. (2023). STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. European geriatric medicine, 14(4), 625-632. https://doi.org/10.1007/s41999-023-00777-y
Quek, H. W., Page, A., Lee, K., Lee, G., Hawthorne, D., Clifford, R., ... & Etherton‐Beer, C. (2024). The effect of deprescribing interventions on mortality and health outcomes in older people: An updated systematic review and meta‐analysis. British Journal of Clinical Pharmacology, 90(10), 2409-2482. https://doi.org/10.1111/bcp.16200
Reeve, E., Thompson, W., & Farrell, B. (2017). Deprescribing: a narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. European journal of internal medicine, 38, 3-11. https://doi.org/10.1016/j.ejim.2016.12.021
Saud Faleh Alanazi. (2024). Comparative Evaluation of the Pharmacological Mechanisms, Clinical Indications, and Risk Management Strategies of Epidural Anesthesia in Surgical and Obstetric Interventions. Saudi Journal of Medicine and Public Health, 1(1), 47–57. https://doi.org/10.64483/jmph-36
Scott, A. J., Hathway, T., Bisby, M. A., Titov, N., & Dear, B. F. (2024). The Sleep Course: An inclusive trial examining the feasibility, acceptability, and preliminary efficacy of a digital sleep intervention for adults with self-reported sleep difficulties. Internet Interventions, 38, 100778. https://doi.org/10.1016/j.invent.2024.100778
Staff, A. U. A. (2015). The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Pharmacoepidemiology and drug safety, 2(1), 1-29.
Sun, W., Sadowski, C., & Farrell, B. (2022). AN INTERPROFESSIONAL APPROACH TO DEPRESCRIBING: A CURRICULAR FRAMEWORK. Innovation in Aging, 6(Supplement_1), 532-533. https://doi.org/10.1093/geroni/igac059.2025
Stolz, R., Krause, O., Junius-Walker, U., Thürmann, P., Fuchs, A., Wilm, S., ... & Haumann, H. (2023). The role of qualification and quality management in the prescription of antipsychotics and potentially inappropriate medication (PIM) in nursing home residents in Germany: results of the HIOPP-3-iTBX study. Aging Clinical and Experimental Research, 35(10), 2227-2235. https://doi.org/10.1007/s40520-023-02513-9
Vaismoradi, M., Mardani, A., Crespo, M. L., Logan, P. A., & Sak-Dankosky, N. (2024). An integrative systematic review of nurses’ involvement in medication deprescription in long-term healthcare settings for older people. Therapeutic Advances in Drug Safety, 15, 20420986241289205. https://doi.org/10.1177/20420986241289205
Warmoth, K., Aylward, A., & Day, J. (2025). Deprescribing within English care homes: guidance and recommendations from the STOPPING project. Health Literacy and Communication Open, 3(1), 2445716. https://doi.org/10.1080/28355245.2024.244571
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Ayed Shabib Shabab Al-Mutairi, Ayed Gaisi, MANSOUR AHMED ALHASSAN ALQARIDHAH, Saad Bashir Eid Al-Balawi, noura Sharid Albishi, Rayed mahmoud husain alamri, Sulaiman Faleh Fahad Alqahtani, Thanaa Ateeq Alsahfi, Njah Mohammad Alanazi, RUBA MOHAMMAD HUSSAIN SHERWANI, noura Sharid Albishi
This work is licensed under a Creative Commons Attribution 4.0 International License.
