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.
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:
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
Nurses are expected to provide a competent level of care that is indicative of their education, experience, skill, and ability to act on agency policies or procedures. In a study of 1,116 hospitals Bond, Raehl, and Franke (2001) found, “Medication errors occurred in 5.07% of the patients admitted each year to these hospitals. Each hospital experienced a medication error every 22.7 hours (every 19.73 admissions). Medication errors that adversely affected patient care outcomes occurred in 0.25% of all patients admitted to these hospitals/year”(p. 4). This means at least one medication error occurs every 24 hours in those facilities studied, and these are preventable errors. The main responsibilities of nurses when administering medications are to prevent or catch error, and report such error. Even if the physician or prescribing health care professional has made a mistake in the order, it is the nurse’s job to question the
Omission of medications is a common issue in the field of nursing. When patients miss their scheduled dosage of medication, it can cause harm. Nurses take an oath to do no harm to their patients. When a nurse purposely omits a medication, they are not properly acting within their nurse’s scope of practice. A nurse cannot make the decision to hold a medication based on ones believes, because they were interrupted, or because of time constraints. “The administration of medications is a major part of the role of the clinical nurse and is an activity prone to error” (Johnson, Tran, & Young, 2011 p. 553).
Taking medication - medications in pill, injectable, liquid and other forms – nursing education / monitoring
Tang, F.I., Sheu, S.J., Yu, S., Wei, I.L., & Chen, C.H. (2007). Nurses relate the contributing factors involved in medication errors. Journal of Clinical Nursing, 16(3), 447-457.Retrived form EBSCOhost.
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.
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,
Compounded with other health issues, he was prescribed with a myriad of medications, ranging from hypertension and blood thinner to bladder spasm drugs. As I watched my aunt, who is a pharmacist, educating my elderly grandfather on polypharmacy, it sparked my interest in pharmacy as I researched all the medicines to get familiar with grandfather’s treatments. To get some insight and explore if this field is right for me, I applied and was offered the opportunity to shadow a pharmacist at UC Davis Hospital. This gave me a first glimpse of how vital pharmacists are in helping patients to recover and stay healthy, and this experience has solidified my desire to be a
Trounce, J. (2000) Clinical pharmacology for nurses: the role of the nurse in drug administration. 16th Ed. London: Churchill Livingstone.
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.
I was also responsible for monitoring medication orders and reviewing patient profiles to ensure that the proper drugs and dosages were prescribed and that the pharmacy technician had prepared them properly. In many instances there were mistakes made in the preparation phase and sometimes even before, with incorrect dosages or drugs being prescribed and prepared, which could result in serious adverse effects for the patient. A clinical pharmacist’s role, however, is to make sure that these mistakes never reach the
Pharmacists often work together in a team with other healthcare professional like physicians and nurses. In the process, pharmacists will give advice to them on the selection of medication, by providing the evidences based on the dosage form, the side effects and possible interaction with food of the medication. On the other hand, pharmacists also take part in research and clinical studies. Recently, pharmacists are recruited to conduct pharmacy-based research in pharmacies. (Swanson, 2005)