A brief summary of the recommendations offered in this guide is provided in checklist format below.

View this guide's detailed recommendations on this webpage. Download a printer-friendly version of this checklist and all recommendation tables here.

Discontinue medications
  Medications that are often unnecessary, provide no to minimal clinical benefit, e.g.,
  • Iron, vitamins including multivitamins, Vitamins A, B1, B3 (Niacin), B6 (Pyridoxine), E, Biotin, Coenzyme Q10
  • Herbal medications: e.g., Ginkgo Biloba, Ginseng, Valerian Root, Echinacea, Red Yeast Rice, Garlic, Saw Palmetto, Flaxseed
  • Others: Docusate, cranberry tablets, glucosamine, low-dose fish oil, probiotics, appetite stimulants
Medications often discordant with goals of care and potential time to benefit, e.g.,
  • Long-term preventive medications (e.g., aspirin, statins) in residents with comfort-oriented care goals or limited life expectancy
Medications appropriate in many residents but safe to temporarily discontinue, e.g.,
  • Calcium, magnesium, bisphosphonates, Vitamin B12, Vitamin D
Reduce frequency of medication-associated monitoring
  • Reduce frequency of monitoring (e.g. heart rate, finger sticks) to track drug effects especially if resident is stable and prior monitoring values/parameters stable. If appropriate, discontinue medications that require frequent monitoring.
Reduce medication dosing frequency
  • Change from short- to long-acting formulations, e.g., metformin, metoprolol, carvedilol, diltiazem, others
  • Change analgesic regimens to allow greater spacing between doses, consolidate laxatives
  • Switch from short- to long-acting insulins, reduce PPIs from twice daily to daily or discontinue
Change timing of doses
  • Move statins (e.g., atorvastatin), alpha blockers (e.g. tamsulosin), levothyroxine to consolidated dosing times
Administer medications differently
  • Change medications that require crushing to liquid formulation if possible; consider liquid/powder potassium
Consolidate administration times
  • Consolidate dispensing times - e.g., q12 hours to BID, eliminate outlier medication administration times
  • Liberalize allowable time period to administer meds
Reduce risks of COVID-19 transmission
  • Use hand-held inhalers (with spacer if possible) instead of nebulizers; consider product(s) availability and usability
  • Where appropriate, change acetaminophen from regular to as-needed dosing to aid in COVID-19 fever surveillance
  • Where possible, avoid directly touching residents when passing meds
  • Reduce unnecessarily frequent monitoring; identify alternatives for meds that require frequent administration