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D2D: How to Implement and Sustain Deprescribing into Your Clinical Practice

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In the post-acute and long-term care (PALTC) setting, managing medications effectively is crucial for optimizing patient outcomes and minimizing harm. Despite the importance of deprescribing, many providers face challenges in this area. This interactive course is designed to equip you with the skills and knowledge necessary to implement effective deprescribing practices in your facility.

Explore Modules

Start with any module that fits your current practice, or complete all of them for a comprehensive approach to deprescribing. New modules will continue to be added as the initiative grows:

  • Module 1: Design Your Deprescribing Intervention
  • Module 2: Deprescribing Communication Techniques
  • Module 3: Optimizing Use of Antipsychotic Medications 

Drive to Deprescribe (D2D) Initiative

Since May 2021, the Post-Acute and Long-Term Care Medical Association (PALTmed) and the American Society of Consultant Pharmacists (ASCP) have been developing resources to optimize medication use in PALTC as part of the Drive to Deprescribe initiative. This course is one of these key resources, created to support health care professionals in providing safe, effective, and patient-centered care.

Additional Resources

Access archived webinars, downloadable tools, and other practical resources by visiting the Drive to Deprescribe resource page

This free offering is part of the Drive to Deprescribe initiative, supporting safe and effective medication use in PALTC through accessible education and resources. No registration fee is required. 

  • Contains 4 Component(s), Includes Credits

    In the post-acute and long-term care (PALTC) setting, managing medications effectively is crucial for optimizing patient outcomes and minimizing harm. Despite the importance of deprescribing, many providers face challenges in this area. This interactive course is designed to equip you with the skills and knowledge necessary to implement effective deprescribing practices in your facility.

    Course Overview

    In the post-acute and long-term care (PALTC) setting, managing medications effectively is crucial for optimizing patient outcomes and minimizing harm. Despite the importance of deprescribing, many providers face challenges in this area. This interactive course is designed to equip you with the skills and knowledge necessary to implement effective deprescribing practices in your facility.

    Areas of Focus

    This module introduces the relationship between medication optimization and deprescribing, providing you with the tools to design an effective deprescribing intervention using the Institute for Healthcare Improvement's Plan-Do-Study-Act (PDSA) model. Future modules in this series will expand on these concepts by covering advanced communication strategies, including techniques for effectively engaging with residents and families, as well as tailored approaches for deprescribing specific classes of medication.

    Background and Development

    Since May 2021, the Post-Acute and Long-Term Care Medical Association (PALTmed) and the American Society of Consultant Pharmacists (ASCP) have been developing resources to optimize medication use in PALTC as part of the Drive to Deprescribe initiative. This course is one of these key resources, created to support health care professionals in providing safe, effective, and patient-centered care.

    Learning Objectives

    Upon completing this module, you will be able to:

    • Assess the impact of deprescribing on managing medication overload.
    • List the four steps of the PDSA model and apply them to a deprescribing intervention.
    • Develop a comprehensive deprescribing plan, considering key design components and strategies.

    Judith L. Beizer, PharmD, BCGP, FASCP, AGSF

    Dr. Judith Beizer is a tenured Clinical Professor at St. John's University College of Pharmacy and Health Sciences in Queens, NY.  As part of her duties, she practices as a Clinical Pharmacist at the Stern Family Center for Rehabilitation in the Northwell Health System.  At the Stern Center, she provides clinical pharmacy services for sub-acute rehabilitation patients, precepts pharmacy students and residents on rotation, and serves on the faculty of the geriatric medicine fellowship program.  Dr. Beizer is a board-certified geriatric pharmacist.

    Dr. Beizer received her bachelor’s degree in pharmacy from the St. Louis College of Pharmacy and then earned a doctor of pharmacy degree from the University of Tennessee.  After pursuing a residency in clinical pharmacy at the Hospital of the University of Pennsylvania, she completed a fellowship in geriatric pharmacy at Montefiore Medical Center in the Bronx, NY.  

    Dr. Beizer is a past president of the American Society of Consultant Pharmacists (ASCP).  She was the 2016 recipient of the George F. Archambault award, ASCP’s highest honor, and the 2001 recipient of the ASCP Richard S. Berman service award.   She is currently serving on the US Department of Veterans Affairs Geriatrics and Gerontology Advisory Committee.  Dr. Beizer is an active member of the American Geriatrics Society (AGS) and serves on their Nominations Committee.  She previously served 9 years on the AGS Public Policy Committee.  She was on the expert panel that developed the 2012, 2015, and 2019 AGS Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.  Dr. Beizer is the Consulting Editor for Pharmacotherapy for the AGS Geriatrics Review Syllabus.

    Cheryl Huckins, MD, CMD

    Cheryl Huckins MD, CMD is the president of the Michigan Medical Directors Association. She is retired from clinical and administrative practice, during which time she has been medical director of multiple extended care facilities, and corporate medical director for Evangelical Homes of Michigan.

    Arif Nazir, MD AGSF FACP

    CHIEF MEDICAL OFFICER

    Signature HealthCARE

    A specialist of internal medicine and geriatric care, Dr. Arif Nazir became Signature’s Chief Medical Officer in January 2016. Dr. Nazir brings more than 12 years of leadership experience from his previous role with the Optimistic Project. He has also received recognition for his work in implementing Indiana’s nursing home value-based purchasing system and his extraordinary work as a faculty member of Indiana University.

    Dr. Nazir was drawn to Signature HealthCARE’s vision of revolutionizing care in the post-acute and long-term care settings. He continues to work on creating the consistent application of basic and foundational, evidence-based geriatric care, and he aims to partner with the best healthcare systems in Signature’s markets.

    Jennifer A. Pruskowski, PharmD, MS, BCPS, BCGP

    Assistant Professor and Director of Geriatric Pharmacy Research and Education

    University of Pittsburgh

    Dr. Pruskowski is an Assistant Professor at the University of Pittsburgh School of Pharmacy and the Director of Geriatric Pharmacy Research, Division of Geriatrics, in the School of Medicine, as well as the Associate Director for Education and Evaluation within the Pittsburgh Veteran Affairs Technology Enhancing Cognition and Health Geriatric Research Education and Clinical Center (TECH-GRECC).

    Kim Ratliff, RN, CNDLTC

    Kim Ratliff, RN, CNDLTC, is the Director of Nursing at Wesley Enhanced Living in West Chester, PA. 

    Sabine Von Preyss-Friedman, MD, FACP, CMD

    Sabine Von Preyss-Friedman, MD, FACP, CMD, is an Internist and Geriatric Medical Specialist and has practiced in Skilled Nursing Facilities since her fellowship at the University of Washington in 1988. She first became a certified Medical Director in 1992 and has since been enthusiastically engaged in Medical Direction of Skilled Nursing Facilities. In 2011, she was honored by AMDA/Society of Post-Acute and Long-Term Care Medicine as Medical Director of the Year. She is Associate clinical Professor Emerita at the University of Washington and Chief Medical Officer of Avalon Healthcare. As a Medical Director and Chief Medical Officer she is involved in Quality improvement, developing standards and outcomes measures in our facility and the successful translation of medical evidence into clinical care. Her mission is to support the best care possible medical care for all of our patients. Dr. von Preyss-Friedman currently serves as the president of the Washington State Society of Post-Acute and Long-Term Care Medicine.

    Chad Worz, PharmD, BCGP, FASCP

    Chad Worz, PharmD, BCGP, FASCP is Chief Executive of the American Society of Consultant Pharmacists (ASCP) in Alexandria, Virginia, the only international professional society devoted to optimal medication management and improved health outcomes for all older persons. ASCP's senior care consultant pharmacist members manage and improve quality of life for geriatric patients and other individuals residing in a variety of environments, including nursing facilities, subacute care and assisted living facilities, psychiatric hospitals, hospice programs, and home- and community-based care. Dr. Worz received his Doctor of Pharmacy degree from the University of Cincinnati College of Pharmacy in Ohio, and he is a board-certified geriatric pharmacist. His career has focused on the medication management of older adults. Dr. Worz developed an innovative clinical practice in a long-term care setting in Ohio and directed the pharmacy practice of a regional, independent pharmacy serving 10,000 long-term care residents. Dr. Worz established a nation-wide, geriatric-based consulting company to educate and serve nursing facility residents, nursing facility administration, long-term care pharmacies, and the public through a comprehensive knowledge of medication use. He is a national thought leader, presenting on pharmacy- and medication-related topics, and he has served on a number of national boards related to pharmacy and medication utilization.

    • 0.5 CME
    • 0.5 CMD Management

    Release Date: 8/14/2024 | Expiration Date: 8/14/2026

    Credit Statements

    Accreditation: Post-Acute and Long-Term Care Medical Association is accredited by the ACCME to provide continuing medical education for physicians.

    CME Designation: Post-Acute and Long-Term Care Medical Association designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    CMD Credit Hours: This CME activity has been pre-approved for up to 0.5 management hour(s) toward certification or recertification as a Certified Medical Director (CMD) in post-acute and long-term care medicine. Each physician should claim only those hours of credit actually spent on the activity. The CMD Program is administered by PALTmed. For further information, contact PALTmed at 410-992-3115 or at certification@paltmed.org.


    Financial Disclosure

    The Association requires the disclosure of all speaker/faculty/planner’s relevant financial relationships; presence of off-label use of a device or medication; and discussion of any experimental, new, or evolving topic prior to each accredited education activity.

    If the learner perceives any bias toward a commercial product or service, advocation of unscientific approaches to diagnosis or therapy, or recommendation, treatment, or manners of practicing health care that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients, please report this to the Association's staff.

    None of the planners, faculty, speakers, or anyone else in control of content disclosed a relevant financial relationship with an ineligible company. 

  • Contains 4 Component(s), Includes Credits

    Learn how to engage PALTC residents and their families in effective conversations about medication deprescribing with this 30-minute, interactive course.

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    Learn how to engage PALTC residents and their families in effective conversations about medication deprescribing with this 30-minute, interactive course, Deprescribing Communication Techniques. Building on the foundational concepts introduced in Module 1, Design Your Deprescribing Intervention, this second module of the series offers a framework and practical strategies to foster trust, promote shared decision-making, and address common concerns around changing or stopping medications.

    Learning Objectives
    At the completion of this module, learners will be able to:
    • Explore the psychological connections residents, family caregivers, and clinicians have with medications 
    • Implement strategies to manage cognitive dissonance
    • Apply the five steps of the FRAME Deprescribing Communication Map

    Acknowledgement
    Funding to support the dissemination of this module was provided by the Foundation for Post-Acute and Long-Term Care Medicine.

    Arif Nazir, MD AGSF FACP

    CHIEF MEDICAL OFFICER

    Signature HealthCARE

    A specialist of internal medicine and geriatric care, Dr. Arif Nazir became Signature’s Chief Medical Officer in January 2016. Dr. Nazir brings more than 12 years of leadership experience from his previous role with the Optimistic Project. He has also received recognition for his work in implementing Indiana’s nursing home value-based purchasing system and his extraordinary work as a faculty member of Indiana University.

    Dr. Nazir was drawn to Signature HealthCARE’s vision of revolutionizing care in the post-acute and long-term care settings. He continues to work on creating the consistent application of basic and foundational, evidence-based geriatric care, and he aims to partner with the best healthcare systems in Signature’s markets.

    Jennifer A. Pruskowski, PharmD, MS, BCPS, BCGP

    Assistant Professor and Director of Geriatric Pharmacy Research and Education

    University of Pittsburgh

    Dr. Pruskowski is an Assistant Professor at the University of Pittsburgh School of Pharmacy and the Director of Geriatric Pharmacy Research, Division of Geriatrics, in the School of Medicine, as well as the Associate Director for Education and Evaluation within the Pittsburgh Veteran Affairs Technology Enhancing Cognition and Health Geriatric Research Education and Clinical Center (TECH-GRECC).

    Sabine Von Preyss-Friedman, MD, FACP, CMD

    Sabine Von Preyss-Friedman, MD, FACP, CMD, is an Internist and Geriatric Medical Specialist and has practiced in Skilled Nursing Facilities since her fellowship at the University of Washington in 1988. She first became a certified Medical Director in 1992 and has since been enthusiastically engaged in Medical Direction of Skilled Nursing Facilities. In 2011, she was honored by AMDA/Society of Post-Acute and Long-Term Care Medicine as Medical Director of the Year. She is Associate clinical Professor Emerita at the University of Washington and Chief Medical Officer of Avalon Healthcare. As a Medical Director and Chief Medical Officer she is involved in Quality improvement, developing standards and outcomes measures in our facility and the successful translation of medical evidence into clinical care. Her mission is to support the best care possible medical care for all of our patients. Dr. von Preyss-Friedman currently serves as the president of the Washington State Society of Post-Acute and Long-Term Care Medicine.

    Chad Worz, PharmD, BCGP, FASCP

    Chad Worz, PharmD, BCGP, FASCP is Chief Executive of the American Society of Consultant Pharmacists (ASCP) in Alexandria, Virginia, the only international professional society devoted to optimal medication management and improved health outcomes for all older persons. ASCP's senior care consultant pharmacist members manage and improve quality of life for geriatric patients and other individuals residing in a variety of environments, including nursing facilities, subacute care and assisted living facilities, psychiatric hospitals, hospice programs, and home- and community-based care. Dr. Worz received his Doctor of Pharmacy degree from the University of Cincinnati College of Pharmacy in Ohio, and he is a board-certified geriatric pharmacist. His career has focused on the medication management of older adults. Dr. Worz developed an innovative clinical practice in a long-term care setting in Ohio and directed the pharmacy practice of a regional, independent pharmacy serving 10,000 long-term care residents. Dr. Worz established a nation-wide, geriatric-based consulting company to educate and serve nursing facility residents, nursing facility administration, long-term care pharmacies, and the public through a comprehensive knowledge of medication use. He is a national thought leader, presenting on pharmacy- and medication-related topics, and he has served on a number of national boards related to pharmacy and medication utilization.

    • 0.5 CME
    • 0.5 CMD Management

    Release Date: 12/16/2024 | Expiration Date: 12/16/2026

    Credit Statements

    Accreditation: Post-Acute and Long-Term Care Medical Association is accredited by the ACCME to provide continuing medical education for physicians.

    CME Designation: Post-Acute and Long-Term Care Medical Association designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    CMD Credit Hours: This CME activity has been pre-approved for up to 0.5 management hour(s) toward certification or recertification as a Certified Medical Director (CMD) in post-acute and long-term care medicine. Each physician should claim only those hours of credit actually spent on the activity. The CMD Program is administered by PALTmed. For further information, contact PALTmed at 410-992-3115 or at certification@paltmed.org.


    Financial Disclosure
    The Association requires the disclosure of all speaker/faculty/planner’s relevant financial relationships; presence of off-label use of a device or medication; and discussion of any experimental, new, or evolving topic prior to each accredited education activity.

    If the learner perceives any bias toward a commercial product or service, advocation of unscientific approaches to diagnosis or therapy, or recommendation, treatment, or manners of practicing health care that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients, please report this to the Association's staff.

    None of the planners, faculty, speakers, or anyone else in control of content disclosed a relevant financial relationship with an ineligible company. 

  • Contains 3 Component(s), Includes Credits

    This 1-hour interactive module, part of the Drive to Deprescribe series, teaches practical strategies for safely reducing antipsychotic use in post-acute and long-term care (PALTC) settings.


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    Optimizing the use of antipsychotic medications, especially in older adults in PALTC, is a challenge. Providers need to determine an accurate diagnosis, weigh the harms and benefits of specific antipsychotics, learn how best to taper medications appropriately, and stay informed of current federal regulations around antipsychotic use. 

    This 1-hour interactive module is part of the Drive to Deprescribe series and is designed to help providers, together with their interdisciplinary teams, develop systematic strategies for rational prescribing, deprescribing, or continuing the use of these medications safely and appropriately. Upon completion, participants can earn CMD Clinical Hours.

    Learning Objectives
    Upon completion of this module, participants should be able to:

    • Assess the appropriateness of antipsychotic use in PALTC settings.
    • Summarize relevant regulations related to antipsychotic use and explain their rationale.
    • Apply eligibility criteria for antipsychotic deprescribing in a patient case.

    Acknowledgement
    Funding to support the dissemination of this module was provided by Neurocrine Biosciences. All content was developed independently by PALTmed, without input or influence from the sponsor.

    Jennifer A. Pruskowski, PharmD, MS, BCPS, BCGP

    Assistant Professor and Director of Geriatric Pharmacy Research and Education

    University of Pittsburgh

    Dr. Pruskowski is an Assistant Professor at the University of Pittsburgh School of Pharmacy and the Director of Geriatric Pharmacy Research, Division of Geriatrics, in the School of Medicine, as well as the Associate Director for Education and Evaluation within the Pittsburgh Veteran Affairs Technology Enhancing Cognition and Health Geriatric Research Education and Clinical Center (TECH-GRECC).

    Michael Cinque, PharmD, FAPhA

    Michael Cinque PharmD, FAPhA, currently serves as the Senior Vice President of Clinical Strategic Partnerships at InnovAge and operates as a consultant in Medication Use Management through Michael Cinque Consulting. Prior experience includes a role as Senior Vice President of Pharmacy Management at Genesis and as President at Enclara Pharmacia, where notable achievements included driving the integration of Enclara Pharmacia with Hospice Pharmacia. Previously, Michael Cinque held positions such as Vice President of Operations at Hospice Pharmacia, overseeing a substantial payroll and managing extensive operations, and Chief Pharmaceutical Care Officer at excelleRx Hospice Pharmacia, where responsibilities included leading clinical operations. Academic credentials consist of a Bachelor of Science in Pharmacy from Temple University School of Pharmacy and a Doctor of Pharmacy degree from the University of Florida.

    Steven Levenson MD, CMD

    Steven Levenson, MD, CMD, was a medical director and physician in PALTC for 43 years. Dr. Levenson passed away on January 24, 2024, at his home in Maryland. He is widely recognized for his pioneering work in medical direction and efforts to improve long-term care and expand its body of knowledge. He has authored or co-authored more than 80 articles and four books, including Medical Direction in Long-term Care and the Subacute and Transitional Care Handbook. Over the past 30 years, he was involved extensively in activities to improve the implementation of the OBRA ‘87 regulations and guidance. Dr. Levenson is a Past President of the Post-Acute and Long-Term Care Medical Association, 2006-2007, and has contributed substantially to numerous PALTmed projects, programs, and publications for the past 35 years. 

    Arif Nazir, MD AGSF FACP

    CHIEF MEDICAL OFFICER

    Signature HealthCARE

    A specialist of internal medicine and geriatric care, Dr. Arif Nazir became Signature’s Chief Medical Officer in January 2016. Dr. Nazir brings more than 12 years of leadership experience from his previous role with the Optimistic Project. He has also received recognition for his work in implementing Indiana’s nursing home value-based purchasing system and his extraordinary work as a faculty member of Indiana University.

    Dr. Nazir was drawn to Signature HealthCARE’s vision of revolutionizing care in the post-acute and long-term care settings. He continues to work on creating the consistent application of basic and foundational, evidence-based geriatric care, and he aims to partner with the best healthcare systems in Signature’s markets.

    Barbara Resnick, PhD, CRNP

    Barbara Resnick, PhD, CRNP, is a professor in the school of nursing at the University of Maryland and the Sonya Ziporkin Gershowitz Chair in Gerontology and combines clinical work as an advanced practice nurse in a CCRC with teaching and research. Her research is focused on optimizing function and physical activity among older adults.

    Sabine von Preyss-Friedman, MD CMD FACP

    CMO

    Avalon Healthcare Inc, Caldera Care

    Dr. Sabine von Preyss-Friedman is an Internist and Geriatric Medical Specialist who has practiced in Skilled Nursing Facilities (SNFs) since her fellowship at the University of Washington. She first became a certified Medical Director in 1992 and has since been passionately engaged in the Medical Direction of SNFs. In 2011, she was honored by AMDA/Society of Post-Acute and Long-Term Care Medicine (now PALTMed) as Medical Director of the Year.As a co-chair of AMDA's acclaimed D2D/Drive to deprescribe initiative she has won the John Gladstone award as well as AMDA's Choosing Wisely award. In addition to providing services as Medical Director for several facilities in the Seattle area, she is an Associate Clinical Professor Emerita at the University of Washington and serves as Chief Medical Officer of Avalon Healthcare and Caldera Care.
    Dr. von Preyss-Friedman is deeply involved in quality improvement, developing standards, and outcome measures in SNFs, and successfully translating medical evidence into clinical care. Her mission is to support the best possible medical care for all patients.
    Dr. von Preyss-Friedman currently is the president – elect of PALTMed/formerly AMDA and immediate past president of the WA Society for Post-Acute and Long-Term care Medicine.

    Lea Watson, MD, MPH

    Lea Watson, MD, MPH, is a geriatric psychiatrist and consultant to the long-term care workforce on issues of behavioral health, psychopharmacology and provider wellbeing.


    Chad Worz, PharmD, BCGP, FASCP

    Chad Worz, PharmD, BCGP, FASCP is Chief Executive of the American Society of Consultant Pharmacists (ASCP) in Alexandria, Virginia, the only international professional society devoted to optimal medication management and improved health outcomes for all older persons. ASCP's senior care consultant pharmacist members manage and improve quality of life for geriatric patients and other individuals residing in a variety of environments, including nursing facilities, subacute care and assisted living facilities, psychiatric hospitals, hospice programs, and home- and community-based care. Dr. Worz received his Doctor of Pharmacy degree from the University of Cincinnati College of Pharmacy in Ohio, and he is a board-certified geriatric pharmacist. His career has focused on the medication management of older adults. Dr. Worz developed an innovative clinical practice in a long-term care setting in Ohio and directed the pharmacy practice of a regional, independent pharmacy serving 10,000 long-term care residents. Dr. Worz established a nation-wide, geriatric-based consulting company to educate and serve nursing facility residents, nursing facility administration, long-term care pharmacies, and the public through a comprehensive knowledge of medication use. He is a national thought leader, presenting on pharmacy- and medication-related topics, and he has served on a number of national boards related to pharmacy and medication utilization.

    • 1.0 CMD Clinical

    Release Date: 6/9/2025 | Expiration Date: 6/9/2028


    CMD Credit Hours: This activity has been pre-approved for up to 1.0 clinical hour(s) toward certification or recertification as a Certified Medical Director (CMD) in post-acute and long-term care medicine. Each physician should claim only those hours of credit actually spent on the activity. The CMD Program is administered by PALTmed. For further information, contact PALTmed at 410-992-3115 or at certification@paltmed.org.