NR-578 · Week 2 of 8 · The deprescribing argument on paper

NR-578 Week 2 The Deprescribing Argument: How to Write It

By Corinne Ashdown, MSN, RN Primary Care Management of Older Adults 8-week session Manual reviewed August 2026
The short answer

A telephone medication review, with a spouse reading bottle labels aloud one at a time and pausing over the two that look identical, produces a list no reconciliation screen in a chart has ever matched. Somewhere in the early applied stages of an older-adult practicum the written work turns to that list and what should be removed from it. Deprescribing is not subtraction; it is an argument, and the argument has a fixed shape: what this drug was started for, whether that indication still holds, what harm it is producing now in a body that handles it differently, what stopping it risks, and how the withdrawal will be monitored. Your section may print this as NR 578 or NR578; it is the same course. Chamberlain publishes no syllabi outside Canvas. The placement here is our teaching judgment from the course's catalog arc; your section's rubric decides what your week actually asks. Clinical hours, encounter logs, site documentation and preceptor evaluations are your own record and are never drafted, reconstructed or estimated with help.

NR-578 Week 2 grading scale at Chamberlain, the criterion levels this assessment is scored on, from Chamberlain Tutors
How Chamberlain grades NR-578 Week 2, visualized by Chamberlain Tutors.

What a medication review document has to contain

The first requirement is a reconciled list with provenance attached to each line. A medication list is not a fact; it is a claim assembled from sources that disagree. The clinic record, the pharmacy dispensing history, the bottles in the house, the facility administration record and what the person actually swallows are five different lists, and the gaps between them are frequently the whole clinical finding. A write-up that presents one tidy list has hidden its own most valuable evidence. A write-up that says the record carried twelve items, the home count found fourteen including two purchased over the counter, and one prescribed item had not been collected in four months has already produced an argument before any pharmacology appears.

The second is an indication test applied to every line, with the original reason and its current status separated. Long medication lists accumulate by drift. A drug started for a temporary problem during an admission six years ago becomes permanent because nobody ever owned the decision to stop it. In writing, each item needs three things: what it was started for, whether that indication is still live, and who currently owns the decision. Where the indication cannot be established, say so directly. Unclear indication is a legitimate written finding and a common trigger for a deprescribing conversation, whereas a guess dressed up as history is a fabrication.

The third is pharmacology written for an ageing body rather than a generic adult. Changes in renal clearance, body composition, protein binding, receptor sensitivity and the ability of the cardiovascular and autonomic systems to compensate all alter what a standard dose does. This is the layer that separates a graduate document from a list of interactions copied out of a checker. The reader needs to see you connect a specific physiological change to a specific consequence for a specific drug in this person, rather than reciting that older adults are more sensitive to medications in general.

The fourth is a prescribing cascade identified where one exists, because it is the finding this territory rewards most. A cascade is a new drug started to treat a symptom that an existing drug caused. It hides in plain sight in long lists and it is invisible unless somebody lines up start dates against symptom onset. Writing one out explicitly, with the sequence and the dates, is the single most impressive thing a student can do in a medication review document, and it converts the whole piece from a description into a diagnosis.

The practicum boundary holds unchanged. The medication review happened in a real encounter, you were present under supervision, and the hours it counted toward, the encounter log, the facility or clinic documentation and the preceptor's evaluation are your own record, never drafted, reconstructed or estimated with help. De-identify the case fully before it reaches the page; a distinctive drug combination is itself an identifier. If a discussion accompanies the assignment, treat the post as final copy, since posts do not reopen after submission in Canvas.

The NR-578 Week 2 method, step by step

Six moves for writing a deprescribing argument that a reader can check.

  1. 1. Reconcile across sources and record the discrepancies

    Build the list from the record, the pharmacy history, the physical containers and the person's own account, then write down where they disagree. The discrepancies are findings, not noise, and burying them costs you the most interesting paragraph in the document.

  2. 2. Test every item against a live indication

    For each drug, name the original reason, state whether it still applies, and say who owns the decision now. Where the indication cannot be established from any source, write unclear rather than inventing a plausible history.

  3. 3. Map start dates against symptom onset to expose cascades

    Lay the sequence out chronologically. A drug started within weeks of a symptom that a previous drug is known to produce is the classic pattern, and demonstrating it with dates is far stronger than asserting that a cascade may be present.

  4. 4. Rank the list by risk rather than by chart order

    Use a recognized approach to potentially inappropriate medication in older adults, cited by name and year, and combine it with what this person's function and physiology make dangerous. Say what put your top item at the top.

  5. 5. Argue one withdrawal fully instead of proposing five vaguely

    Choose the single change with the best ratio of benefit to disruption and write it completely: the taper or stop, the interval, what could return, what withdrawal effect is expected and how it is distinguished from the original condition coming back.

  6. 6. Write the monitoring plan and the reversal condition

    Who checks what, when, by which route, and what specifically would make you restart. A deprescribing plan without a defined way back is an experiment with no stopping rule, and graders in this territory look for that sentence.

A layout and word budget for a medication review document

Our frame for a deprescribing case, sized for roughly 1,200 to 1,500 words. It is our own outline rather than anything the university issues, and your week's rubric outranks it wherever the two disagree.

ElementWhat belongs in itWord target
Person and function in briefDe-identified age band, functional position, renal and hepatic status, and who manages the medications day to day.110 to 150
Reconciliation and its gapsThe sources used, the discrepancies found between them, and what each discrepancy suggests.190 to 240
Indication auditEach item with its original reason, its current status, and an explicit unclear where the history cannot be established.220 to 280
Ageing pharmacology appliedThe specific physiological changes in this person and the specific drug consequences that follow from them.200 to 250
Cascade or risk rankingAny sequence exposed by dates, plus the risk ordering with the criteria and source that produced it.190 to 250
One withdrawal arguedThe taper or stop, the interval, the expected withdrawal picture and how it is told apart from relapse.230 to 290
Monitoring and reversalWho checks what and when, the route, the person who will notice a change, and the condition that restarts the drug.160 to 210

Evidence craft for medication review writing

Cite a named criteria set rather than asserting inappropriateness. Explicit criteria for potentially inappropriate prescribing in older adults exist, are revised periodically and carry the authority your judgment needs. Name the criteria and the edition year in the sentence where you apply them.

Give renal function as a value with its method, not as an adjective. Dose adjustment arguments rest on an estimate, and estimates differ by equation and by the weight used. Report the number, the equation and the date so a reader can follow the adjustment you made.

Separate an interaction that matters from one a checker flagged. Software returns many alerts and few of them change management. Write the mechanism, the expected clinical consequence in this person, and why it does or does not alter the plan. A list of flagged pairs demonstrates that a tool was run, not that reasoning occurred.

Report benefit with the time it takes to arrive. Preventive therapies have a lag before benefit appears, and that lag has to be weighed against the person's likely trajectory. Naming the delay, with a source and its year, is the honest way to argue that a drug no longer earns its place without turning the paragraph into a prognosis.

Attribute what the patient and family said about each drug. Which tablets they believe are important, which they skip, which they cannot afford and which are hard to swallow are all evidence, and they belong in the document with the person who reported them named by role rather than by name.

Five mistakes that cost points at this stage

  • One tidy list with no provenance. Presenting a reconciled list without saying where the sources disagreed removes the evidence the assignment was built to elicit.
  • Interaction checker output pasted in as analysis. A table of flagged pairs shows a tool ran. The graded content is which one changes management in this body and why.
  • Indications invented to fill a gap. Writing a plausible reason for a drug whose history you could not establish is fabrication. Unclear indication is a legitimate and useful finding.
  • Stopping proposed with no taper and no monitoring. Several drug classes carry real withdrawal risk, and a plan without an interval or a reversal condition reads as unsafe rather than decisive.
  • Five changes at once. A document proposing simultaneous withdrawals makes any resulting change uninterpretable, and the reasoning behind that constraint is itself worth a sentence.

Before you submit

  • The reconciliation names its sources and reports the discrepancies between them
  • Every medication carries an original indication and a current status
  • Anything with no establishable history is written as unclear rather than guessed
  • Renal function appears as a value with its equation and date
  • A named criteria set is cited with its edition year where it is applied
  • Any cascade is demonstrated with a dated sequence rather than asserted
  • One withdrawal is argued fully, with taper, interval and expected picture
  • The monitoring plan names who checks what, when, and what would restart the drug

Writing the NR-578 medication review?

Send the rubric and your de-identified list out of Canvas. A premium original draft comes back in 24 to 48 hours with the reconciliation discrepancies argued, ageing pharmacology applied to this body and one withdrawal written with its taper and reversal condition, and revisions run until the grade lands. The hours, the logs and the evaluations stay entirely yours.

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Questions students ask about this stage

The prescriber was a specialist who is not going to take my call. How do I write the plan?
Write it as a coordination problem, because that is what it is, and coordination is a competency the course is testing. State clearly which items sit outside primary care's decision-making, name the specialty that owns each, and then write what you would propose and how you would propose it: the question you would send, the information the specialist would need to answer it, and what primary care would do in the interim. That is a real plan. What does not work is a document that quietly proposes stopping a specialist's medication as though the authority were yours, and it is one of the more common ways students lose points in this territory. It also does not work to abandon the analysis because the decision belongs elsewhere. The written argument for why an item deserves review has value independent of who executes it, and articulating that argument clearly is precisely what makes a referral useful when it lands on someone else's screen.
How do I write about medications the patient buys without a prescription?
As part of the list, with the same indication test applied and with the extra work that they are frequently invisible to every record you have. Over the counter analgesics, sleep aids, antacids, supplements and herbal products all carry real interaction and organ risk in older adults, and several of them duplicate prescribed items without the patient realizing it. In the write-up, say how you established what was actually being taken, since this is the layer a chart never holds: asking what is in the bathroom cabinet, asking what is taken for pain on a bad day, asking about anything bought for sleep. Then apply the same reasoning you applied to prescribed items, including dose, frequency and duration, because an occasional tablet and a nightly one are different exposures. Where a supplement has thin evidence behind it, write that accurately rather than dismissively, and say what specifically concerns you about it in this person.
My patient wants to stop a drug I think should continue. What does the document say?
It says both positions, accurately, and then does the analytic work of finding the actual disagreement. Usually the conflict is narrower than it first appears. A person who wants to stop a tablet often objects to a specific effect, a cost, the number of tablets, or a swallowing problem rather than to the drug itself, and naming that lets you write a plan addressing the real objection: a change of formulation, a different agent in the same class, a dose reduction, or a trial off with an agreed way back. Write what you explained about the risk of stopping, in the terms you actually used, and write what they said in response. If they still choose to stop, document it as an informed decision with the safety net attached, since that is a legitimate outcome and pretending otherwise misrepresents the encounter. The competency being scored here is negotiation under uncertainty, not persuasion, and a document that treats a patient's preference as an obstacle usually loses marks in the professional communication row.
Does a facility medication administration record count as a source I can cite?
You can describe what you observed in the course of the encounter and use it in your clinical reasoning, and that is normal practice for a case document. What you should be careful about is the difference between reasoning from a record and reproducing one. Your academic write-up needs the clinically relevant content in de-identified form: which drugs, which doses, what pattern of administration, what was refused or held and how often. It does not need, and should not contain, transcribed pages of a facility document, identifiers, staff names or anything that would let a reader locate the resident or the site. The facility's records, like your hour log and your preceptor's evaluation, belong to a documentation system you do not author. Use them the way you use any clinical observation, which is as the basis for reasoning that you then write in your own words.

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