NURS 6630N WEEK 5-De-Prescribing Assignment Paper

 NURS 6630N WEEK 5 ASSIGNMENT INSTRUCTIONS

 What is the importance of de-prescribing? How might you assist a patient to taper from a medication safely or transition to a new medication?

In this Assignment, you will use the following patient examples to write a 5- to 6-page paper on considerations you have for how you might de-prescribe. Support your answers with five (5) evidence-based, peer-reviewed scholarly literature resources outside of Required Learning Resources in this course.

Note: APA style format guidelines will apply. NURS 6630N WEEK 5-De-Prescribing Assignment Paper

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Patient Examples:

Patient 1: A 36-year-old male presents to your office being prescribed by his primary care physician (PCP) for the past 3 years an opioid analgesic medication for a work accident. He has chronic pain and is attending a pain clinic. It is determined the best course of treatment for pain is to remain on opioid medication. The patient is also being prescribed clonazepam 1mg BID for “relaxation” and panic attacks.

Patient 2: A 42-year-old female on alprazolam 1mg BID for panic attacks. Panic attacks have been in remission and the patient wants to taper off the medication. But, every time she has attempted to do so in the past, she experienced withdrawal effects. She is wondering how to safely taper off the benzodiazepine medication without having withdrawal effects.

Patient 3: A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder. She recently found out she is pregnant (9 weeks gestation). She was referred to you by her OB-GYN to discuss this medication for her current situation. The patient is wondering if she can stay on the lorazepam through her pregnancy and postpartum, as it is an effective medication for anxiety symptoms. She plans to exclusively breastfeed for the first 6 months postpartum. She has not had any other trials of medication to treat anxiety as lorazepam has been effective. NURS 6630N WEEK 5-De-Prescribing Assignment Paper

Patient 4: A 71-year-old-male who comes to see you at the insistence of his daughter. His daughter expresses concern of memory loss and is wondering if he has the beginning stages of dementia. He is forgetful and seems to be tripping on things or walking into walls, although he has lived in the same home for the past 35 years. The patient does not agree with his daughter but does admit he has had a “few stumbles and falls” lately. Medication reconciliation shows the following medications: metoprolol ER 50mg q day, omeprazole 20mg q day, clonazepam 1mg TID, levothyroxine 75mcg q am. His daughter is wondering if he should be started on a “dementia medication.”

TO PREPARE FOR THIS ASSIGNMENT

• Review the assigned Learning Resources for this week.
• Review the definitions presented in your text and resources for de-prescribing and tapering.
• Consider the importance of de-prescribing.
• Based on the example(s) provided, consider how you might de-prescribe a patient.

Answer the following questions using the patient examples described above. NURS 6630N WEEK 5-De-Prescribing Assignment Paper

Patient 1

• What are the concerns of the patient remaining on the opioid medication and clonazepam?
• How might you educate the patient about these risks and concerns?

The patient agrees that he should not continue both medications in combination. He would like to “get off” the clonazepam but worries about “bad withdrawals” that he’s heard about from stopping clonazepam “cold turkey” and is concerned about re-occurring panic attacks. How might you respond to the following:

• How would you instruct the patient to taper off clonazepam?
• What other medication would you recommend for the patient for the treatment of his panic attacks? Keep in mind, he will continue the opioid medication for pain relief.
• How would you start the new recommended psychotropic medication for the patient?
• Discuss one legal, ethical, or social consideration with the treatment plan. NURS 6630N WEEK 5-De-Prescribing Assignment Paper

Patient 2

• The patient reports withdrawal symptoms when previously tapering off the alprazolam. What symptoms are common withdrawal symptoms from this medication?
• Provide the patient education of withdrawal symptoms that range from common and less serious to withdrawal symptoms that are a cause for concern and that should prompt patient should seek medical attention.
• Given the patient’s history of having withdrawal effects from attempting to taper off alprazolam, what longer-acting benzodiazepine would you choose to convert the patient to?
• What is the dose you would prescribe and how would you taper off the medication? NURS 6630N WEEK 5-De-Prescribing Assignment Paper

Patient 3 

• Review the potential risks, benefits, and side effects of continuing lorazepam throughout the pregnancy and postpartum for both the patient and fetus.
• Review other alternative medications to treat generalized anxiety disorder. Include risks, benefits, and potential side effects to both the patient and the developing fetus. Keep in mind, the patient is looking to breast feed for 6 months postpartum.
• The patient agrees that it would be safest for her pregnancy and fetus to discontinue the lorazepam. How would you recommend she discontinue lorazepam? Provide education on potential side effects from tapering off the medication, including common side effects to more serious side effects and when to seek medical attention.
• The patient would like to forgo medications at this time, given she is early in her pregnancy and is concerned about “damage” to the fetus if she were to continue medications. Provide education to the patient about the risks of untreated anxiety symptoms during pregnancy for both the patient and the fetus.

Patient 4

• Review potential side effects for elderly on benzodiazepines providing education to both the patient and the patient’s daughter. What are the risks of continuing the benzodiazepine for this patient? NURS 6630N WEEK 5-De-Prescribing Assignment Paper
• How would you evaluate the patient for these side effects?
• The patient and daughter agree he will need to taper off the clonazepam given the risks of continuing this medication. How would you recommend tapering off this medication?
• Review with the patient and daughter potential side effects of tapering off the medication. Review with them common side effects to more serious side effects and when to seek medical attention.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Walden Writing Center Sample PaperLinks to an external site. provides an example of those required elements.

De-Prescribing: A Comprehensive Approach to Patient Care

Deprescribing involves decreasing or discontinuing medicines that are unnecessary, dangerous, or no longer serving the patient. Deprescribing is crucial to reduce the hazards of improper or extended pharmaceutical usage in today’s healthcare environment, when polypharmacy is rising, particularly among older persons and those with multiple comorbidities. Medicine can be potentially hazardous when given incorrectly, taken for prolonged periods, or mixed with other substances. Unexpected outcomes such as hospitalizations, adverse drug reactions, drug-drug interactions, or any unanticipated effects can increase healthcare costs while simultaneously decreasing the quality of living for the patients in care. Deprescribing involves carefully considering each medication against its potential benefits in light of each patient’s medical history, treatment goals, and circumstances.  NURS 6630N WEEK 5-De-Prescribing Assignment Paper Deprescribing entails checking an individual’s pharmaceutical regimen for adverse effects, drug interactions, and compliance concerns while determining whether it fits all their requirements. Deprescribing actively reduces superfluous or harmful prescriptions to optimize a patient’s treatment regimen, lessen side effects, and improve health results. Healthcare practitioners, patients, and caregivers must communicate to make educated choices. Deprescribing is necessary because age-related physiological and pharmacological changes and chronic disorders render older persons more susceptible to drug side effects. Deprescribing can reduce falls caused by polypharmacy, cognitive impairment, or adverse side effects – and thus help keep older people safer overall. Deprescribing can have an enormously positive impact on healthcare and society alike. Reducing drug usage saves costs, prescriptions, and money for healthcare costs; deprescription only works through collaboration among physicians, pharmacists, and nurses – it must also include constant patient monitoring to assess response to changes pharmacologically and manage withdrawal symptoms or rebound effects effectively. NURS 6630N WEEK 5-De-Prescribing Assignment Paper

Patient 1: 36-year-old male with chronic pain and panic attacks

Concerns about remaining on opioid medication and clonazepam: Combining opioid analgesics like clonazepam with benzodiazepines might cause drug interactions and adverse effects. These drugs may cause respiratory depression, severe sedation, and drug interactions (Akita et al., 2021); long-term usage may cause tolerance, dependence, abuse, and addiction (Wang et al., 2023).

Education on risks and concerns: Patients should be warned of the risks of using opioid analgesics with clonazepam, including life-threatening respiratory depression, excessive drowsiness, cognitive impairment, falls/accidents, dependence, addiction, and withdrawal symptoms (Wang et al., 2023). They should understand its severity to make informed decisions and follow any suggested treatment strategies (Wang et al. 2023).

Tapering off clonazepam: Based on their history of panic attacks, medically supervised tapering may be recommended in order to minimize sudden withdrawal symptoms (Wang et al., 2023) that may worsen panic attacks or withdrawal symptoms (Wang et al., 2023). Gradual tapering allows both body and mind to gradually adapt over time while minimizing rebound anxiety episodes or panic episodes (Wang, 2023).

Recommendation for new medication for panic attacks: Since chronic pain management requires opioids, non-benzodiazepine panic attack therapies should be examined. Sertraline, paroxetine, and venlafaxine may help panic disorder (Goldin, 2023). These medications may cure panic attacks without benzodiazepine adverse effects (Goldin, 2023).

Legal, ethical, or social considerations: Opioids and benzodiazepines are strictly controlled to prevent misuse and diversion. Healthcare providers must ethically weigh the risks and benefits of concurrent use based on the patient’s circumstances, therapeutic goals, and well-being. A comprehensive treatment plan should incorporate the patient’s support system, living situation, and drug addiction potential. Family and caregiver involvement and tools may improve adherence and outcomes. NURS 6630N WEEK 5-De-Prescribing Assignment Paper

Patient 2: 42-year-old female with panic attacks

Common withdrawal symptoms from alprazolam: Stopping short-acting benzodiazepine alprazolam quickly might cause withdrawal. Ait-Daoud et al. (2018) mention withdrawal symptoms as anxiety, insomnia, irritability, restlessness, muscle tension, and sweating. Severe alprazolam withdrawal may produce convulsions, psychosis, and life-threatening delirium tremens (Reid Finlayson et al., 2022). Tapering must be carefully handled due to the patient’s panic attack history and probable withdrawal symptoms. NURS 6630N WEEK 5-De-Prescribing Assignment Paper

Education on withdrawal symptoms: The patient must be informed of probable withdrawal symptoms during tapering. This should cover anything from anxiety and sleeplessness to seizures and insanity. Teaching patients how to recognize and report these symptoms may assist in guaranteeing early intervention and therapy. If she has significant withdrawal symptoms, she should seek medical help immediately to ensure her safety throughout tapering (Reid Finlayson et al., 2022).

Selection of longer-acting benzodiazepine for tapering: For tapering, the patient’s history of alprazolam withdrawal may recommend switching to clonazepam or diazepam (Reid Finlayson et al., 2022). Tapering with longer-acting benzodiazepines may minimize withdrawal symptoms because of their smoother onset and offset.

Prescribed dose and tapering plan: The longer-acting benzodiazepine dose and tapering schedule should be tailored to the patient. The appropriate starting dose and taper should consider her existing alprazolam dosage, duration of use, and clinical status. Longer-acting benzodiazepines are progressively lowered over weeks or months to allow the patient’s body and brain time to adapt (Reid Finlayson et al., 2022). Tapering must be monitored closely to maintain patient safety, manage withdrawal symptoms, and change the strategy as required. Weaning off benzodiazepines, despite possible challenges, is essential to manage their long-term hazards, especially in patients like this who have panic episodes. Using a longer-acting benzodiazepine, a tapering strategy, patient education on withdrawal symptoms, and continuous monitoring, healthcare practitioners may safely and reliably move patients off alprazolam without severe withdrawal symptoms. NURS 6630N WEEK 5-De-Prescribing Assignment Paper

Patient 3: 24-year-old female with generalized anxiety disorder and pregnancy

Risks, benefits, and side effects of continuing lorazepam during pregnancy: Lorazepam can harm a growing child if consumed by a pregnant woman. Edinoff et al. (2021) observed that lorazepam-using neonates have lower birth weight, early delivery, fetal anomalies, and withdrawal symptoms. The placenta may absorb lorazepam rapidly. Low birth weight, early delivery, and mother-child development can result from untreated pregnancy anxiety (Bishaw et al., 2022).

Alternative medications for anxiety during pregnancy: SSRIs like fluoxetine and sertraline are safer than benzodiazepines for pregnancy anxiety. These medications reduce baby congenital malformations and withdrawal symptoms. The patient’s circumstances, anxiety level, and health should be considered while determining the risks and benefits of any pharmacological treatment. NURS 6630N WEEK 5-De-Prescribing Assignment Paper

Discontinuation of lorazepam during pregnancy: Lorazepam must be slowly tapered off when pregnant and supervised by a doctor. Edinoff et al. (2021) suggest a gradual taper to reduce withdrawal symptoms and fetal damage. Consider the patient’s dosage, duration, and past drug discontinuation efforts when creating the tapering plan.

Education on potential side effects from tapering off lorazepam: As part of the tapering plan, inform the patient of any withdrawal adverse effects. Increased anxiety, sleeplessness, agitation, and muscle cramps are side effects (Edinoff et al., 2021). A safer tapering technique for the lady and her pregnancy may include explicit instructions on when to seek medical assistance for severe withdrawal symptoms and how to detect and manage common side effects.

Risks of untreated anxiety during pregnancy: Lorazepam discontinuation during pregnancy may benefit the infant, although uncontrolled anxiety is a problem. Uncontrolled stress and anxiety during pregnancy may cause preterm delivery, low birth weight, and developmental issues (Bishaw et al., 2022). Untreated anxiety may impair the mother’s health and ability to care for the baby. To lessen these risks, cognitive-behavioral therapy, mindfulness, and relaxation strategies should be researched for pregnant anxiety management (Bishaw et al., 2022). NURS 6630N WEEK 5-De-Prescribing Assignment Paper

Patient 4: 71-year-old male with memory loss concerns

Side effects of benzodiazepines in the elderly: Drugs like clonazepam may harm seniors. Fractures, falls, dementia, delirium, and cognitive impairment may follow, according to Rochon et al. (2017). Rochon et al. (2017) propose that benzodiazepines accelerate geriatric cognitive deterioration. His 71-year-old age and history of memory loss necessitate assessing clonazepam’s cognitive and functional effects.

Evaluation for side effects: Comprehensive screening is essential for clonazepam side effects. The drug may affect the patient’s memory, attention, processing speed, and cognitive abilities. Clonazepam side effects may increase falls or recent injuries; thus, a gait and balance examination is needed. Since beginning or increasing clonazepam, caregivers or family members like the patient’s daughter may help identify changes in cognitive performance, behavior, or functional status (Rochon et al., 2017). NURS 6630N WEEK 5-De-Prescribing Assignment Paper

Tapering off clonazepam: For elderly adults, tapering and stopping clonazepam under medical supervision may be advised due to the risks of long-term usage. To reduce withdrawal symptoms and adverse effects, tapering should be gradual and matched to the patient’s dosage, duration, and medical requirements (Reid Finlayson et al., 2022). Considering the patient’s health and cognitive function, the medical team should discuss discontinuing clonazepam with him and his family. NURS 6630N WEEK 5-De-Prescribing Assignment Paper

Education on potential side effects of tapering off clonazepam: Tapering requires informing the patient and daughter about withdrawal adverse effects. Reid Finlayson et al. (2022) include anxiety, sleeplessness, irritability, muscular cramps, and seizures as adverse effects. Negative results abound. Giving patients instructions on how to recognize and manage these side effects and when to seek emergency medical assistance for more severe withdrawal symptoms may make tapering safe and effective. Promote following the tapering strategy and engaging with the healthcare team to guarantee clonazepam discontinuation.

Critical Analysis and Synthesis of Literature

De-prescribing is complicated and patient-centered. The research emphasizes numerous essential factors and evidence-based de-prescribing techniques. A complete medication evaluation, clinical status, comorbidities, and drug-drug interactions are needed initially (Wang et al., 2023). Each medication’s dangers and benefits should be reviewed based on patient requirements and preferences. Second, de-prescribing requires patient education and participation in decision-making (Reid Finlayson et al., 2022). Clear explanations of de-prescribing, withdrawal symptoms, and management can enhance adherence and minimize anxiety during tapering. Third, benzodiazepines and opioids, which can cause withdrawal, should be tapered gradually and carefully (Wang et al., 2023; Reid Finlayson, 2022). A moderate, personalized tapering program with continuous monitoring and follow-up can reduce withdrawal symptoms and enhance patient outcomes. Fourth, cognitive-behavioral therapy, mindfulness, and exercise can treat anxiety and chronic pain without medication (Goldin, 2023; Bishaw et al., 2022).NURS 6630N WEEK 5-De-Prescribing Assignment Paper  Finally, de-prescribing prohibited pharmaceuticals or prescriptions that may be misused or diverted requires legal, ethical, and societal issues (Wang et al., 2023). Comprehensive de-prescribing requires compliance with rules, assessment of the patient’s support system, and resolving any impediments.

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Conclusion

            Patient-centered care requires de-prescribing to optimize pharmaceutical regimens, manage side effects, and improve outcomes. These cases demonstrate the importance of a comprehensive and customized de-prescribing approach that considers patient education, medication reviews, legal, ethical, and social factors, mainly controlled substances, and gradual tapering schedules for high-risk medications. Patients, caregivers, and healthcare professionals must prioritize collaborative decision-making and evidence-based de-prescribing approaches. Patients’ quality of life, side effects, and medication safety improve. Tomorrow, de-prescribing activities should focus on standardizing methods and suggestions for specific patient groups and medication classes and studying long-term impacts, implementation challenges, and possible solutions. NURS 6630N WEEK 5-De-Prescribing Assignment Paper

LEARNING RESOURCES:

• Goldin, D. S. (2023). Fast facts for psychopharmacology for nurse practitioners. Springer Publishing.
  • Chapter 6, “Anxiolytics and Anti-Anxiety Medications“ (pp. 85–110)
  • Chapter 11, “Sleep Disorders” (pp. 228–247)
• Community Behavioral Health. (2019, February). Clinical guidelines for tapering benzodiazepinesLinks to an external site.. https://cbhphilly.org/wp-content/uploads/2019/02/Helping-Patients-Taper-from-Benzodiazepines-FINAL-3.pdf
• National Center for PTSD. (2013). Effective treatments for PTSD: Helping patients taper from benzodiazepinesLinks to an external site.. https://www.va.gov/painmanagement/docs/OSI_6_Toolkit_Taper_Benzodiazepines_Clinicians.pdf
• Ogbonna, C. I. & Lembke, A. (2017). Tapering patients off of benzodiazepinesLinks to an external site.. American Family Physician, 96(9), 606–608. https://www.aafp.org/pubs/afp/issues/2017/1101/p606.html
• comLinks to an external site.. (2023). https://www.drugs.com/
  Note:Please use the following resource to check the most up-to-date box warnings, FDA approvals and indications, recommendations for follow-up evaluations, changes, etc.
• Anxiolytic Medication Table
  Note:Utilize the following medication table to familiarize yourself with the medications aligned with the topics presented this week. NURS 6630N WEEK 5-De-Prescribing Assignment Paper

*Indicates off-label use

Note: Also review SSRI/SNRI and TCA tables from previous weeks.

                                             LAST WEEK’S TABLE

NOTE BELOW:

Students who use subheadings/paragraphs in their posts get better grades.

PLEASE USE SUBHEADINGS/PARAGRAGHS

WEEK 5 ASSIGNMENT RUBRIC
NURS_6630_Week5_Assignment_Rubric
NURS_6630_Week5_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomePatient 1: Describes concerns for patient remaining on the medication and how these risks and concerns will be addressed to the patients. Describes how to assist Patient 1 in tapering medication, as well as what other medication might be prescribed with considerations of legal, ethical, or social considerations to the plan. 20 to >18.0 pts
Excellent
The response comprehensively describes medication risks and concerns. The response comprehensively and clearly explains how the patient will be educated. The response comprehensively and clearly explains considerations for medication tapering. The response comprehensively and clearly reflects on legal, ethical, or social considerations of the plan. 18 to >15.0 pts NURS 6630N WEEK 5-De-Prescribing Assignment Paper
Good
The response clearly describes medication risks and concerns. The response clearly explains how the patient will be educated. The response clearly explains considerations for medication tapering. The response clearly reflects on the legal, ethical, or social considerations of the plan. 15 to >10.0 pts
Fair
The response inaccurately or vaguely describes medication risks and concerns. The response inaccurately or vaguely explains how the patient will be educated. The response inaccurately or vaguely explains considerations for medication tapering. The response inaccurately or vaguely reflects on legal, ethical, or social considerations of the plan. 10 to >0 pts
Poor
The response vaguely or inaccurately describes medication risks and concerns, or it is missing. The response includes inaccurate and vague examples that does not explain how the patient will be educated, or it is missing. The response vaguely or inaccurately explains considerations for medication tapering, or it is missing. The response includes inaccurate and vague examples that does not reflect on legal, ethical, or social considerations of the plan, or it is missing.
20 pts
This criterion is linked to a Learning OutcomePatient 2: Describes common withdrawal symptoms and patient education information. Describes which benzodiazepine might be prescribed to convert the patient, as well as the specific dosing and tapering information. 20 to >18.0 pts
Excellent
The response comprehensively and clearly explains withdrawal symptoms. The response comprehensively and clearly provides patient education information. The response comprehensively and clearly identifies a benzodiazepine for the patient. The response comprehensively and clearly details dosing and tapering information. 18 to >15.0 pts
Good
The response clearly explains withdrawal symptoms. The response clearly provides patient education information. The response clearly identifies a benzodiazepine for the patient. The response clearly details dosing and tapering information. 15 to >10.0 pts
Fair
The response inaccurately or vaguely explains withdrawal symptoms. The response inaccurately or vaguely provides patient education information. The response inaccurately or vaguely identifies a benzodiazepine for the patient. The response inaccurately or vaguely details dosing and tapering information. 10 to >0 pts
Poor
The response vaguely or inaccurately explains withdrawal symptoms, or it is missing. The response includes inaccurate and vague examples that does not provide patient education information, or it is missing. The response vaguely or inaccurately identifies a benzodiazepine for the patient, or it is missing. The response includes inaccurate and vague examples that does not detail dosing and tapering information, or it is missing.
20 pts
This criterion is linked to a Learning OutcomePatient 3: Describes potential risks, benefits and side effects of lorazepam, as well as alternative medications that might be prescribed for the patient. Describes how the patient might discontinue lorazepam, with necessary patient education regarding discontinuing medication and patient/fetus needs. 20 to >18.0 pts NURS 6630N WEEK 5-De-Prescribing Assignment Paper
Excellent
The response comprehensively and clearly describes risks, benefits and side effects of lorazepam. The response comprehensively and clearly identifies potential alternative medications. The response comprehensively and clearly describes how the patient might discontinue the medication. The response comprehensively and clearly provides necessary education for discontinuing the medication for patient and fetus. 18 to >15.0 pts
Good
The response clearly describes risks, benefits and side effects of lorazepam. The response clearly identifies potential alternative medications. The response clearly describes how the patient might discontinue the medication. The response clearly provides necessary education for discontinuing the medication for patient and fetus. 15 to >10.0 pts
Fair
The response inaccurately or vaguely describes risks, benefits and side effects of lorazepam. The response inaccurately or vaguely identifies potential alternative medications. The response inaccurately or vaguely describes how the patient might discontinue the medication. The response inaccurately or vaguely provides necessary education for discontinuing the medication for patient and fetus. 10 to >0 pts
Poor
The response vaguely or inaccurately describes risks, benefits and side effects of lorazepam, or it is missing. The response includes inaccurate and vague examples that does not identify potential alternative medications, or some or all are missing. The response vaguely or inaccurately describes how the patient might discontinue the medication, or it is missing. The response includes inaccurate and vague examples that does not provide necessary education for discontinuing the medication for patient and fetus, or some or all are missing.
20 pts
This criterion is linked to a Learning OutcomePatient 4: Describes potential risks and side effects of continuing benzodiazepine. Describes how to taper the medication and education regarding the tapering. 20 to >18.0 pts
Excellent
The response comprehensively and clearly describes potential side effects and risks. The response comprehensively and clearly describes how to taper the medication. The response comprehensively and clearly provides necessary patient education for tapering. 18 to >15.0 pts NURS 6630N WEEK 5-De-Prescribing Assignment Paper
Good
The response clearly describes potential side effects and risks. The response clearly describes how to taper the medication. The response clearly provides necessary patient education for tapering. 15 to >10.0 pts
Fair
The response inaccurately or vaguely describes potential side effects and risks. The response inaccurately or vaguely describes how to taper the medication. The response inaccurately or vaguely provides necessary patient education for tapering. 10 to >0 pts
Poor
The response vaguely or inaccurately describes potential side effects and risks, or it is missing. The response vaguely or inaccurately describes how to taper the medication, or it is missing. The response includes inaccurate and vague examples that does not provide necessary patient education for tapering, or some or all are missing.
20 pts
This criterion is linked to a Learning OutcomePaper demonstrates critical thinking and synthesis of literature with five (5) evidence-based, peer reviewed scholarly references 5 to >4.0 pts
Excellent
Paper demonstrates critical thinking and synthesis of literature with five (5) evidence-based, peer reviewed scholarly references outside of course resources. 4 to >3.0 pts NURS 6630N WEEK 5-De-Prescribing Assignment Paper
Good
Paper demonstrates some critical thinking and/or vague synthesis of literature with four (4) evidence-based, peer reviewed scholarly references outside of course resources. 3 to >1.0 pts
Fair
Paper demonstrates vague critical thinking and/or little synthesis of literature with three (3) evidence-based, peer reviewed scholarly references. 1 to >0 pts
Poor
Paper demonstrates no critical thinking and/or synthesis of literature with two (2) or less evidence-based, peer reviewed scholarly references.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria. 5 to >4.0 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria. 4 to >3.0 pts NURS 6630N WEEK 5-De-Prescribing Assignment Paper
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the Assignment is stated yet is brief and not descriptive. 3 to >1.0 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the Assignment is vague or off topic. 1 to >0 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion was provided.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors. 4 to >3.0 pts
Good
Contains one or two grammar, spelling, and punctuation errors. 3 to >1.0 pts
Fair
Contains several (three or four) grammar, spelling, and punctuation errors. 1 to >0 pts
Poor
Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting: The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 to >4.0 pts
Excellent
Uses correct APA format with no errors. 4 to >3.0 pts
Good
Contains one or two APA format errors. 3 to >1.0 pts NURS 6630N WEEK 5-De-Prescribing Assignment Paper
Fair
Contains three or four APA format errors. 1 to >0 pts
Poor
Contains many (five or more) APA format errors.
5 pts
Total Points: 100

Review the assigned Learning Resources for this week.
Review the definitions presented in your text and resources for de-prescribing and tapering.
Consider the importance of de-prescribing.
Based on the example(s) provided, consider how you might de-prescribe a patient.
What is the importance of de-prescribing? How might you assist a patient to taper from a medication safely or transition to a new medication?

In this Assignment, you will use the following patient examples to write a 5- to 6-page paper on considerations you have for how you might de-prescribe. Support your answers with five (5) evidence-based, peer-reviewed scholarly literature resources outside of Required Learning Resources NURS 6630N WEEK 5-De-Prescribing Assignment Paper