July 28, 2025
The first two modules in the Drive to Deprescribe (D2D) course—Design Your Deprescribing Intervention and Deprescribing Communication Techniques—have been extremely popular. Based on the initial reaction to the latest module, Optimizing Use of Antipsychotic Medications, PALTmed has another hit on its hands.
Course Director Jennifer Pruskowski, PharmD, MS, BCPS, BCGP, CPE, says this is an important, although somewhat controversial, topic for post-acute and long-term care clinicians.
“I think folks all know that antipsychotics carry an increased risk of stroke, sedation, falls, and even death in older adults, especially those with dementia. These aren't mild side effects. They're serious and potentially life-threatening, which is why these medications carry a black box warning, the highest level of warning from the FDA,” she explains. “It's a tough spot. In the post-acute and long-term care setting, clinicians are often trying to respond quickly to stressful symptoms and behaviors like agitation or aggression, which can be common in residents suffering from dementia.
The impulse to help restore calm in these situations is entirely understandable, but as Dr. Pruskowski notes, “I think what ends up happening is sometimes antipsychotics become a go-to solution despite all of their risks. And this pattern has led to concerns about overuse, lack of informed consent, and missed opportunities to provide safer, more patient-centered approaches first.”
She adds that this controversy isn't about blaming clinicians. Instead, “it's more about taking the time to step back and recognize the complexity of care and making sure that we’re doing what we think is truly best for that individual each and every time.” This course module was created to help with that.
While Dr. Pruskowski recommends completing the first two modules before tackling this one, it’s not absolutely necessary. “Modules one and two lay the foundation for developing deprescribing therapeutic plans and being able to talk to residents, their care partners, and other clinicians about implementing your plan,” she says. “However, the curriculum is designed to be flexible so you can jump around and make it whatever fits your needs.”
According to Dr. Pruskowski, more modules are on the horizon, focusing on additional medication classes like antihyperglycemics, proton pump inhibitors, anti-dementia medications, and benzodiazepines. She says the course will also continue to explore the value of interprofessional teamwork and try to leverage deprescribing regarding culture change, since effecting lasting improvement takes a team effort.
Please send an email to Alicia Graf at agraf@paltmed.org if you have any other suggestions for additional modules or have questions about the course in general.
Get more information about the new module here. You can find specifics about the other modules and the D2D initiative as a whole under the Drive to Deprescribe tab.
