Table 1.

Recommendations to Reduce Medication Burden

Type of recommendation	Examples or comment
Medications that may be discontinued (temporarily or permanently)	Vitamins, herbal medications, appetite stimulants, bisphosphonates (temporarily), and long‐term preventive medications (e.g., statins and aspirin) in people with comfort‐oriented goals or limited life expectancy
Medications that can be changed to require less frequent dosing	Metoprolol tartrate → metoprolol succinate; consolidate laxatives to be administered at a single time; discontinue short‐acting insulins
Medications whose monitoring can be changed	Consider reducing the frequency of monitoring of pulse, blood pressure, and fingerstick glucose in residents who are stable; if a medication requires frequent checks but may not be needed (e.g., short‐acting insulins), consider discontinuation
Administer medications at different times to reduce number of medication passes	Administer statins and alpha‐blockers with other medications during day (not a separate pass at bedtime)
Medications that require crushing	Change to liquid formulations if possible to ease burden of administration
Align medication administration times	Eliminate outlier medication administration times if not necessary; change “every 12 hours” medications to “twice daily” unless medication requires precise dosing interval
Convert nebulizers to handheld inhalers where possible	To avoid aerosolization of SARS‐CoV‐2. Many people with cognitive impairment can successfully use metered‐dose inhalers with a spacer or breath‐actuated devices.
Consider replace standing dose acetaminophen with as‐needed dosing to aid in fever surveillance	Special caution with this recommendation to avoid worsening of pain control, especially for residents unable to communicate or advocate for their own needs.
Enhance hygiene during medication passes	Observe resident hand hygiene before handing medications; if appropriate, place medications on bedside table rather than handing directly to resident

Note: Incomplete list. For the full list, please view the guide.5

Abbreviation: SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2.