DWARAA
ਦੁਆਰਾ — dwaraa, a Gurmukhi word meaning “through,” “by way of,” or “via.” It can also be read as a passage or a gateway. It is used here for the gateway to better care through deprescribing and improved dementia care.
DWARAA is six steps, in order, and the order is the argument. You cannot support cognition in someone who is sedated, you cannot assess a resident you have not established a baseline for, and you cannot call any of it care planning if the plan never changes.
- Deprescribing for Health Optimization
- Well-Being and Cognitive Enhancement
- Assessment of Individual Care Needs
- Reducing Medication Burden
- Advocating for Non-Pharmacological Interventions
- Adjusting Care Plans Based on Ongoing Evaluation
The six steps
Deprescribing
The tools, and the two harms — falls from over-tight blood pressure, and glycemia.
Well-being and cognition
What goes in place of the medication, and why the corridor is an intervention.
Assessment
The causes that get missed, and why behavior is communication.
Reducing burden
Burden is not count. The prescribing cascade, read in date order.
Non-pharmacological
The eight items — the largest single category in the review.
Adjusting the plan
The step that decides whether the other five were real.
And restraints
Chemical and physical restraint reduction is the same work seen from the other end. Restraint-free care · the 49 items in the review.
About Dr. Gurpreet Singh Padda, MD, MBA, MHP
Dr. Gurpreet Singh Padda, MD, MBA, MHP is the Authorized Official of CareGuard, the role the Patient Safety Act assigns to the person who certifies a Patient Safety Organization’s compliance to AHRQ. He is the point of contact on the federal listing for PSO P0268.
He is board certified in anesthesiology, interventional pain, addiction medicine, obesity medicine and pain medicine, and has practiced in St. Louis for more than three decades. The clinical positions CareGuard works from — that medication burden in long-term care is usually higher than it needs to be, and that restraints are a failure of care planning rather than a tool — are his.
Questions people actually ask
What does DWARAA mean?
ਦੁਆਰਾ is a Gurmukhi word meaning “through,” “by way of,” or “via” — a passage or gateway. The letters also carry the six steps of the program. Learn more: Deprescribing in long-term care.
Is deprescribing safe?
Done as a discipline, with a prescriber, it is the correction of an accumulated problem. Done abruptly and alone it is dangerous — several classes rebound and several must be tapered. Learn more: Deprescribing in long-term care.
My relative is on a blood pressure medication and keeps falling. Is that connected?
It can be, through orthostatic hypotension, and it is one of the specific pathways this program looks at. It is a conversation to have with the prescriber. Learn more: Blood pressure medication and falls in older adults.