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both the patient and prescriber. The process of deprescribing can often take longer than the initiation of treatment, careful consideration at the outset, consultation with the patient and regular follow up may be perceived as a barrier due to time constraints. 44 However, this might be contrary to patient perception because patients on multiple medications are, on the whole, quite willing to consider a trial withdrawal of their medication. 46 Recommendations Pharmacists, in view of their skills, knowledge, and in-depth understanding of disease states and their pharmacological management are able to advise on appropriate deprescribing within the elderly care multidisciplinary team (MDT). Pharmacist contributions to the MDT, in the form of medication reviews and contributions to the patient’s clinical management plan, allow for the discontinuation of unnecessary and sometimes harmful medicines. Cost savings in the region of £135 million per year could potentially be achieved through safe and appropriate deprescribing in a care home setting. 47 These savings might actually be greater because this sum does not take into account the efficiencies and savings that occur due to the reduction in hospital admissions secondary to adverse drug events. In addition to undertaking medication reviews in a holistic manner that addresses health and social care needs, pharmacists can also contribute to the process of deprescribing through the delivery of education and training to increase the competence and confidence of staff involved in this activity. Pharmacists can also assist in the development of guidelines and critical appraisal of current literature relating to deprescribing, assimilation of the key points and proposing recommendations to support their application to a real life clinical setting. 47 There is mounting evidence that can positively improve the care of older patients through the process of medicines optimisation. 48 Deprescribing may take this a step further because the process will require clinical expertise and potentially the use of tacit knowledge to ensure patient safety, quality of life and clinical outcomes are not compromised. 12 The involvement of pharmacists within the MDT improves pharmaceutical care. 49,50 The acceptance rates of pharmacist interventions, including dose adjustments and deprescribing, can be as high as 80%, particularly in the elderly care setting. 51 This demonstrates the evolving role of the pharmacist within the MDT and the increasing importance of collaborative working between specialist groups involved in the care of adults. Pharmacists play a pivotal role in influencing and driving deprescribing, with a view to ensuring continuous review of medicine regimes and reducing inappropriate polypharmacy. Conclusions The evidence base to support the concept of deprescribing is very much in its infancy, but is rapidly growing in view of increased awareness and understanding of the benefits, to both patients and the National Health Service, through the discontinuation of medications that are no longer clinically indicated or unlikely to improve clinical outcomes or prognosis. Fundamental to the process of deprescribing is a paradigm shift in the way in which healthcare providers view the prescribing and administration of medications. Pharmacists, with their level of knowledge around medicines are well placed as a member of the MDT to identify and initiate the deprescribing process. 24 | Issue 90 | 2018 | hospitalpharmacyeurope.com References 1 National Institute for Health and Care Excellence. 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