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.
Zwicker D., Fulmer T. (2012) Reducing adverse drug events (ADE) in older adults focuses on drug-drug interactions, drug-disease interactions, iatrogenic ADE’s, poor medication adherence, pharmacodynamics and polypharmacy. According to Zwicker D, Fulmer T. (2012) “Around 31% of all adverse events in hospitals are caused by medication-related problems.” This guideline is developed to promote safety in the hospital and after discharge. It is comprehensive in providing assessment tools to promote medication safety such as Beers Criteria and the Cockcroft Gualt formula to determine renal failure. The guideline assesses functional capacity in both independent activities of daily living and functional activities of daily living as well as cognitive capacity. Zwicker D, Fulmer T. (2012) advised completing a brown bag method of reviewing all medication as part of the assessment in order to include all medication an older adult has at home including over the counter medication herbs,...
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...ternally who reviewed for validation.
Works Cited
Bergman-Evans B. Improving medication management for older adult clients. Iowa City (IA): University of Iowa College of Nursing, John A. Harford Foundation Center of Geriatric Nursing Excellence; 2012 May. 31 p. [117 references]. Retrieved from http://www.guideline.gov/content.aspx?id=37826
Hanlon, J. T., Schmader, K. E., Ruby, C. M., & & Weinberger, M. (2001). Suboptimal prescribing in older inpatients and outpatients. Journal of the American Geriatrics Society, 49 200–209(2), 200-209.
Zwicker D, Fulmer T. Reducing adverse drug events. In: Boltz M, Capezuti E, Fulmer T, Zwicker D, editor(s). Evidence-based geriatric nursing protocols for best practice. 4th ed. New York (NY): Springer Publishing Company; 2012. p. 324-62. Retrieved from http://www.guideline.gov/content.aspx?id=43938
When doctors prescribe medication for their patients, a local retail pharmacy is most likely to be utilized to fill the order. However, there is a growing population of older Americans that are no longer able to live independently and must reside in nursing homes or assisted living facilities. In order for this vulnerable population to receive their medications, a different kind of pharmacy is needed, these are known as LTC, long term care pharmacies. Within these specialized pharmacies there are highly trained employees called CPhTs, certified pharmacy technicians who are overseen by state licensed RPHs, otherwise known as pharmacists.
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:
...teract. Many of the medications are very powerful in and of themselves. This article also presents additional approaches to medicating the elderly, including focus on reduction of number of medications prescribed. Both articles present the importance of considering the normal physiological changes within geriatric patients.
The New England Journal of Medecine. A Controlled Trial of Inpatient and Outpatient Geriatric Evaluation and Management, 346, 905-912. Retrieved on November 8th, 2006 from http://content.nejm.org/cgi/content/full/346/12/905
April Hazard Vallerand, Cynthia A. Sanoski, & Judith Hopfer Deglin (2013). Davis’s drug guide for nurses thirteenth edition. Philadelphia: Robert G. Martone
This service is experienced, documented, evaluated and paid for as Pharmaceutical Care. Pharmaceutical Care consists of a philosophy of practice, patient care process as well as a patient management system. Pharmaceutical Care has common integrated vocabulary consistent with other patient care practices such as medicine, dentistry and nursing. Philosophy of pharmaceutical care consists of a description of the social need for the practice, a concise and clear statement of individual practitioner responsibilities to meet this social need, the expectation to be patient-centered and the requirement to function within the caring paradigm. This philosophy of practice is expected and practiced by all health care professionals. The patient care processes must be consistent with the patient care processes of all other health care providers. These processes include the assessment of the client’s pharmaceutical needs, a health care plan that is constructed to meet the specific needs of the client and a process in which evaluates the health care plan to gauge the efficacy of decisions made and actions taken. Pharmaceutical care management system includes all resources needed to manage the client’s needs, which include the space provided, such as a clinic or hospital, an appointment system for patients, appropriate and ethical documentation, reporting of patient care, evaluation of decisions made and actions taken and payment of service
Vallerand, April Hazard, Cynthia A. Sanoski, and Judith Hopfer Deglin. 2013. Davis's Drug Guide for Nurses. 13th ed. Philadelphia: F. A. Davis Company.
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?
Studies have shown that patients fail to adhere and comply with medicines because of lack of understanding. [1] Gordon et al (2007) conducted a study which aimed to identify medication related problems and identify approaches to support patients to manage their medication. Problems with access to and the organisation of services was one of the findings highlighted from the study. Pharmacy can address the issues associated with organisation of services, patient education and engaging patients in decision making about their medicines in the home during consultation.
As people age, their body goes through changes. One of the most common changes is decreased visual acuity (Touhy, Jett, 2012). Decreased visual acuity can lead to taking the wrong medication, which could have detrimental effects to the patient. Elderly patient also experience a decrease in saliva and esophageal motility and impairs their ability to swallow pills (Touhy, 2012). In addition, fat tissue can more that double in elderly adult (Touhy, 2012). A buildup of fat tissue becomes important when administering lipid-soluble drugs because, the drug can be absorbed by the fat and create a toxic effect (Touhy, 2012). Lastly, most elderly adults have slower metabolisms which results in delayed gastric emptying (Touhy, 2012). This becomes important because, some medications will not make it to the small intestine to be absorbed in time to cause their therapeutic effects (Touhy, 2012).
Nurse researchers collected data from chart reviews, staff reports, incident reports and an adverse drug event log. They then reported their findings to the reviewers, two physicians who specialized in evaluating adverse events. In addition, the authors used scales that ranged from not harmful to harmful and grouped as ordering, filling, administration, monitoring or wrong dose (Rothschild,
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.
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?
...Jaecker, P. (2009). Medication use and increased risk of falls in hospitalized elderly patients: A retrospective, case-control study. Drugs & Aging, 26(10), 847-852. doi:10.2165/11317610-000000000-00000
Rovers, John P. A Practical Guide to Pharmaceutical Care. Washington, D.C.: American Pharmaceutical Association, 1998. Print.