PAWSIC: Deprescribing for Healing: The Pharmacist's Role in the Stalled Wound

Wound care clinicians routinely assess perfusion, pressure, nutrition, and bioburden — yet the medication list is rarely examined as a modifiable cause of delayed healing. In post-acute care, where most patients are older adults with multiple chronic conditions, polypharmacy is the norm, and many commonly prescribed agents act directly on the cellular machinery of repair. This moderated panel brings two pharmacists with expertise in geriatric pharmacotherapy and post-acute consultant practice into dialogue with a geriatrician and certified wound specialist physician. Panelists will review how specific drug classes impair healing: corticosteroids through suppression of fibroblast proliferation, collagen synthesis, and angiogenesis; anticoagulants through cutaneous necrosis and bleeding risk; proton pump inhibitors through micronutrient malabsorption; and antibiotics through effects on collagen cross-linking and tensile strength when used without confirmed infection. The panel will also address glucose-lowering therapy and the consequences of both inadequate and overly aggressive glycemic management in diabetic foot ulcers. The session then turns to intervention, describing practical approaches to medication review and deprescribing — including use of the AGS Beers Criteria®, assessment of anticholinergic and sedative burden, and management of drug-drug and drug-disease interactions. Particular attention will be paid to how age-related changes in renal and hepatic function, frailty, and goals of care reshape the risk-benefit calculation for older adults. Attendees will leave with a structured framework for identifying medication-related barriers to healing and for initiating collaborative conversations with prescribers, consultant pharmacists, and patients.