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Table 2 Potential actions to help prevent, detect or resolve prescribing cascades

From: Patient and provider perspectives on the development and resolution of prescribing cascades: a qualitative study

1 Increase the role for community pharmacists and for pharmacists or nurse practitioners working in interprofessional primary care teams, to conduct medication education and review, including the potential for using medical directives to facilitate monitoring and prescribing
2 Have prescribers document the reason for medication use, and rationale for changes, on each prescription
3 Facilitate access to complete and centralized electronic health records by all members of the health care team (to document, provide and share information about medication use, chronology and experience)
4 Apply judicious use of alerts in electronic health records, pharmacy dispensing systems and medication reviews for medication combinations that could be prescribing cascades
5 Confirm the existence of a prescribing cascade through deprescribing and monitoring
6 Modify primary care and pharmacy workflow to increase frequency of follow-up when medication changes are made for older people who may lack awareness or capacity to monitor the effects of medications
7 Incorporate prescribing pitfalls (including prescribing cascades) with tangible examples into medical education
8 Educate the public encouraging them to ask questions about their medications
9 Provide patient education (in lay language and sensitive to cultural context and varying cognitive abilities) about medication purposes and side effects to look for