What deprescribing frameworks have been most practical for frail older adults with multimorbidity in SNFs? I’m in a 72-bed facility doing monthly med reviews; Beers and STOPP/START help, but I’m looking for a concise, patient-centered tool or template that balances symptom control with function, falls, and cognition during our 10-minute huddles.
But sTOPPFrail v2 plus the deprescribing.org algorithms became our 10‑minute huddle script — start with anticholinergics, sedatives/Z‑drugs, and sliding‑scale insulin, then anything without a current indication. > tool or template that balances symptom control with function, falls, and cognition during — stick a 3‑box cue on the MAR: target symptom, 30‑day function/falls risk, taper/monitor plan. MedSafer can auto‑generate a one‑pager if you have access; otherwise STOPPFrail alone has been enough — would that fit your 72‑bed monthly flow?
Building on @j_reyes78, a mini‑TRIM card works for our 10‑minute huddles: start with “what matters this month?”, then run the short list through MedStopper to rank tapers and print the plan for the MAR (https://medstopper.com) — like triage tags for meds. If your team’s new to this, narrow to one class per month; want a one‑pager template?
In our 72-bed unit, we pared ARMOR into a two-line prompt on the MAR — “does this med help comfort or participation this week?” and “any new dizziness or confusion since last change?” — then during the brief stand-up we pick one drug and set a small dose reduction with a 14-day check-in; it keeps things patient-centered beyond Beers/STOPP. Small caveat: I park anticoagulation and other disease-modifying meds for a separate, goal-of-care chat if stroke or organ protection is the primary aim.
, this drives me nuts during monthly med reviews too. Building on @j_reyes78, we use Shed-MEDS as the skeleton plus a quick time‑to‑benefit check via ePrognosis (https://eprognosis.ucsf.edu) so in rapid huddles we ask: “no current indication, no expected benefit in 30–90 days, or no monitoring plan — then taper or stop.” Want a copy of the one‑page Shed‑MEDS checklist we laminated for SNF use?
I’ve had the best luck with STOPPFrail v2 plus a 30‑second Drug Burden Index snapshot; it keeps the huddle aimed at meds that hit falls and cognition. If DBI’s >1, we pick one sedating/anticholinergic to taper and set a quick functional marker (e.g., fewer near‑falls, clearer mornings) and ask, “is this still pulling its weight?”. Would that slot into your brief reviews better than Beers/STOPP‑START alone?
For 10-minute huddles, NO TEARS + MedStopper (https://medstopper.com) quickly flags high fall/cog burden; reconcile PRNs first.
ARMOR has been the most ‘10‑minute‑friendly’ for us — run through it, then jump straight into the class algorithm from deprescribing.org (PPIs, benzos, antipsychotics) so the taper steps are pre‑baked: https://deprescribing.org/clinical-tools/. In the huddle, ask ‘what’s today’s goal?’ and target the med that clashes most with it (e.g., steadier transfers), then set a 72‑hour check; it’s like pruning one branch at a time. If cognition’s fragile or there’s a fresh fall, I swap the order to lighten anticholinergic load first.