Five State Collaborative to Reduce Unnecessary Medications


Qsource, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Alabama, Indiana, Kentucky, Mississippi, and Tennessee, is working to improve safe medication use across the region. To facilitate the work, atom has convened a medication safety advisory board called TIMES (Team for Innovation in MEdication Safety). The group consists of two or three members from each atom state. They represent multiple healthcare settings, including home health providers, hospitals, pharmacies, long-term care facilities, as well as patients and families. All members have a passion for medication safety and a desire to improve patient care.

TIMES is focused on improving medication safety through reducing unnecessary polypharmacy. Research shows that polypharmacy comes with increased rates of adverse events in older adults, but that deprescribing is effective in reducing polypharmacy1. Though definitions vary slightly, one published definition of deprescribing is, “the process of withdrawal of an inappropriate medication, supervised by a healthcare professional with the goal of managing polypharmacy and improving outcomes”.2

To increase awareness of unnecessary medications and assist healthcare providers with deprescribing, TIMES released a deprescribing algorithm focused on the proton pump inhibitor (PPI) medications. PPIs are often used unnecessarily and are associated with adverse effects such as increased fracture risk, pneumonia, C. difficile infection, and low vitamin B12 or magnesium.

The algorithm is available here: TIMES invites anyone interested to download the algorithm and share experiences in using it. Since the algorithm is a quality improvement intervention, TIMES will track its distribution and request occasional feedback from those who use it. The above link will take you to a web form that requests specific information before downloading the algorithm. Completing the information is crucial to the success of this initiative and TIMES appreciates your willingness to share it. Your personal information will never be shared, and any data shared will be aggregated and not traceable to any individual or organization.

TIMES is working on additional algorithms to assist with deprescribing in other medication classes as well, including those related to opioid pain medications and diabetes. Please join us in making improving safe medication use across the region. To ask question or receive more information, please contact Amanda Ryan, PharmD, BCGP at


  1. JAMA Intern Med. 2015 May;175(5):827-34.
  2. Br J Clin Pharmacol. 2015 Dec;80(6):1254-68.