Introduction Polypharmacy among the elderly is a growing concern in U.S. healthcare system. Patients who have comorbities and take multiple medications are at a higher risk for potential adverse drug reactions. There is a great need for nursing interventions in conducting a patient medication review also known as “brown bag”. As nurses obtain history data from patients at a provider visit, the nurse should ask “what medications are you taking?” and the answer needs to include over-the-counter medications as well. If the response does not include any medications other than prescribed meds, it is incumbent upon the nursing professionals to question the patient further to ensure that no over-the-counter medications or supplements are being consumed. This is also an opportunity for the nurse to question about any adverse reactions the patient may be experiencing resulting from medications. Polypharmacy can result from patients having multiple prescribers and pharmacies, and patients continuing to take medications that have been discontinued by the physician. Nurses are in a unique position to provide early detection and intervention for potentially inappropriate medications and its associated adverse drug reactions. Project Purpose PICO Question: Among the elderly patients receiving care at Cary Medical Center on Med/Surg, who are currently taking multiple medications due to comorbidities, would reviewing medications at each provider visit reduce polypharmacy and its associated adverse reactions? Currently, through observations and clinical experience on Med/Surg at Cary Medical Center, medication is administered by the nurse. Nurses are responsible and accountable for administrating medications to patients. Patient me... ... middle of paper ... ...d a gap in the number of studies conducted regarding this issue. From the studies reviewed, the results demonstrate that the increasingly health related issue of polypharmacy among the elderly requires the immediate attention of health care professionals. The studies revealed that in conjunction with medication reviews (brown bag), the STOPP criteria is a tool in which can be effective in detecting PIMs. The studies also revealed that nurses are in the position to address and assess for adverse drug reactions associated with polypharmacy by utilizing the “brown bag”, medication review, and STOPP criteria. Regarding the PICO question, the results of these studies support the essential need of medication reviews to be implemented by nurses and healthcare professionals at every provider visit to reduce the risk of polypharmacy and its associated adverse reactions.
...estions if not 100% sure of something or use a double checking system. When a nurse is administrating medication, they should use the ten rights of medication administration (right patient, right drug, right route, right time, right dose, right documentation, right action, right form, right response, and right to refuse). Nurses should always keep good hand hygiene and always wear appropriate clothing to prevent from the spread of disease. Good communication with patients and healthcare team members is also key to success. Keeping on the eye on the patient within an appropriate time is important. If the patient ever seems to be looking different than their usual self vitals should be taken immediately. Encouraging patients to ask questions if they are unaware of something can prevent errors as well. Nurses should make sure the patient is on the same page as they are.
Lucian L. Leape Conducted a study in 1995 on “health policy analyst at the Harvard School of Public Health, found that 6.5 percent of patients at two teaching hospitals in Boston had been injured by their medicines, and one-third of these cases involved mistakes” (Stolberg, 1999). Due to this Study the F.D.A. official were convinced that the danger of prescription cascade is growing which prompted them to release a 150-page report which was made public, that called for pharmacists, doctors, hospitals and drug companies to work together to create ' 'a new framework ' ' for cutting down on overlapping prescription that have a high risk of causing a cascade. Explicit warning pamphlets were also created according to the new guidelines which requires manufacturers to release side effect possibilities in high risk drugs. (Stolberg, 1999)
The geriatric population is rapidly growing as individuals continue to benefit from medical advances and pharmaceutical treatments. A large number of this population will need to take some form of medication to maintain a functional lifestyle. Multiple medications can affect the elderly population differently than younger generations. This paper will discuss how polypharmacy impacts geriatrics and the will focus specifically on analgesics and antihistamines. It will also examine demographic factors, changes within the aging body, prescription and nonprescriptive medications, and the role of the nurse practitioner when caring for these patients.
Taking medication - medications in pill, injectable, liquid and other forms – nursing education / monitoring
When administering medications it is critical to pay great attention to the task at hand. This task becomes more important when administering medications to the elderly because of the different physiological and psychological changes that occur in the body. Equally important are, the lab values related to the medications being administered, differences in administering medications to the elderly, and the use of the six rights and three checks.
As we age, the use of medication is often increased in an effort to treat illness and disease. In older adults this frequently results in the administration of multiple medications, both appropriately and inappropriately, at the same time. This is known as polypharmacy. While polypharmacy can exist with any age demographic, it is much more prevalent in older adults where the risk of multiple health conditions is greater. It is not uncommon, for example, for a patient to be treated with multiple therapeutic drug combinations in order to manage disease such as diabetes, heart failure and chronic obstructive pulmonary disease (Kaufman, 2011, p. 49). Polypharmacy is associated as a major factor placing older adults at risk for an adverse drug event. As the number of medications increase, the need for monitoring becomes much more crucial. When there is a breakdown in proper monitoring, the older adult is significantly placed at a higher risk for negative health outcomes due to serious side effects, poor adherence, adverse drug reactions and adverse drug interactions.
Polypharmacy is the “concurrent use of several differ drugs and becomes an issue in older adults when the high number of drugs in a medication regimen includes overlapping drugs for the same therapeutic effect”(Woo & Wynne, 2011, p. 1426). The patient is currently taking several medications that can potential interact with each other, perform the same therapeutic effect, and creating side effects. The following is a list of her medications and their indications:
During the years of 1999-2000 only 6.3 percent of Americans used five or more medications, and then in the years of 2007-2008 about 10.7 percent of Americans used five or more medications, that is a 4.4 percent increase. In the last decade alone the use of five or more medications has increased 70 percent. Creating the stronger need for healthcare providers to communicate about the care of their patients is becoming evident. However in recent years more hospitals are using electronic medical records that can be sent to each healthcare provider, this helps the patient relive some of the stress in remembering what all medications they take and the dosages they are taking. Also healthcare providers can now see when their patient was last in to see another doctor and what there diagnosis was creating a more stable health system and less medication reactions. Although there is always room error but if every hospital adopts this system there is a good possibility that polypharmacy may be a thing of the past. Polypharmacy is becoming a fatal epidemic for the elderly, it is pertinent to know the risks and ways to prevent
Polypharmacy among the elderly is a growing concern in U.S. healthcare system. Elderly who have comorbities and take multiple medications are at a higher risk for potential adverse drug reactions. Elderly who take over-the-counter medications, herbs, and supplements without consulting their physician are at risk for adverse reactions associated with polypharmacy. Polypharmacy can result from patients having multiple prescribers and pharmacies, and patients who continue to take medications which have been discontinued by the physician. There is a great need for nursing interventions regarding polypharmacy, including medication reviews also known as “brown bag”. As nurses obtain history data and conduct a patient assessment, it is essential to review the patients’ medications and ask open-ended questions regarding all types of medications in which the patient is taking. In addition, the patient assessment is also an opportunity for the nurse to inquire about any adverse reactions the patient may be experiencing resulting from medications. Nurses are in a unique position to provide early detection and intervention for potentially inappropriate medications and its associated adverse drug reactions.
Continuing to review a patient’s medication profile while residing in a healthcare facility every six to twelve months and with any medication alteration (Pham and Dickman, 2007). This frequency of review would allow for re-evaluation of current medications and discontinuation if applicable (Pham and Dickman, 2007). In addition, adverse drug reactions are known to occur more often in women, children, the elderly and in patients with renal insufficiency (Woo and Wynne, 2012). Close monitoring of these high risk populations would also provide opportunity to minimize adverse drug reactions in combination with close monitoring of the known high risk medications such as antiepileptic drugs, and antidepressants (Woo and Wynne,
If a patient is confused or thinking of altering their medication regimen the nurse and/or physician should be informed
Proper medication management among older adults can be challenging. Older persons may not fully understand the purpose of the medication and the importance of following the prescription as directed. Over the counter medication, herbs and supplements may not be considered medication; therefore, they do not inform their health care provider that they are taking them. Multiple health care providers can result in duplication of orders or adverse drug reactions. Improper management of medication may lead to adverse drug events ultimately extending a hospitalization or decreasing an older adult’s ability to function safely. Obtaining an accurate record of medications at all points of care promotes safer medication administration and prevents adverse events.
Pharmacists have an impact on how often patients are taking their medications by making sure they are aware of the
In the process of taking the patient's drug history, asking for other possible medication is not the best way to inquire other things that the patient may be taking. A better way is going systematically and asking by category such as any herbal products that she may be taking. Another possible way of framing the question is by enquiring if there is any other product that she may be using that mat not have been prescribed by a doctor. This will enhance the chances of owning in cases of polypharmacy.
Medication discrepancies account for approximately 25% of hospitalizations in older adults (Lancaster, Marek, Denison-Bub, & Stetzer, 2014, p. 536). There are approximately 1.5 million preventable adverse drug events each year, costing $3.5 billion (Lang, et al., 2015, p. 2). There are many factors that play into medication errors in the home, one of the primary causes is a lack of understanding of changes to the medication administration regimen on the part of the home care client, family, or caregiver (Lancaster, Marek, Denison-Bub, & Stetzer, 2014, p. 536). When the home care nurse understands the multi-dimensional factors that contribute to medication errors and conducts a comprehensive medication reconciliation, adverse medication events can be decreased. This paper will discuss the risk factors for adverse medical events in the home care setting, provide research information regarding adverse medication events, define medication reconciliation, and provide information on how to complete a thorough medication reconciliation for home care clients.