Due to the risk to for noncompliance from multiple medications, uncontrolled chronic health conditions and impaired vision of the patient, the family’s reasons for referral to a home health care coincided with the physician’s as well. Three major safety concerns validated this decision: several medications throughout the day, multiple co-morbidities, and advance age. Her ability to properly manage her medications was questioned when the healthcare team suspected she was uncompliant with her Carvedilol prescription, which consequently resulted in a hypertensive crisis. The progression of her chronic conditions, especially her kidney failure and recurrent dialysis treatment, affects her quality of life and increases her risk for complications.
Med-Pharmex Incorporated is known nationally and abroad as a pharmaceutical manufacturer of animal-related products. Before gaining fame worldwide, the business began its journey to success as a small lab in 1983, which slowly grew over time. Since then, the company maintains its main goal, and that is to produce drugs that promote the health of companion animals, such as dogs, cats, and horses, as well as food-producing animals, such as pork and chickens. To ensure legal responsibility, the company’s manufacturing process is examined by the United States Food and Drug Administration (FDA). Med-Pharmex works closely with veterinary clinics who purchase their life-saving drugs and represent them in the market. Despite manufacturing drugs, the
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:
DaVita is a for profit acute and chronic hemodialysis, peritoneal, and home hemodialysis provider operating internationally. Acute renal failure and chronic kidney disease affects millions of persons, with new diagnoses occurring each and every day. These diagnoses are typically exacerbated from the number one and number two causes of renal disease, which are diabetes and hypertension. Renal disease management requires a collaborative approach between healthcare providers, patients, and families. Outcomes are directly related to the decisions patients make outside of the healthcare setting. As healthcare professionals, it is imperative that patients and families are educated regarding the acute and chronic kidney disease, making healthy
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.
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
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.
The practice of over prescribing medication is a recent problem facing many today. This is referred to as the prescribing cascade. Dr. Mehrdad Ayati an assistant professor of medicine at the Stanford University School of Medicine, describes Prescription cascade in the following statement “To put this simply, a patient goes to a doctor’s office with an illness and is given a prescription this prescription has a side effect that causes another illness, and now the patient, unaware that the prescription is the problem, visits the same, or another doctor and is given another prescription. Then this prescription result in a new side effect, which sends the patient to the same, or yet another doctor for the new symptom, and
Hypertension is one of the most prevalent disorders in the US, affecting about 1 in 3 adults. Since uncontrolled blood pressure has been linked to consequences such as stroke, congestive heart failure, and chronic kidney disease, it poses considerable risk for a significant portion of the population. According to the American Heart Association, hypertension was responsible for 46,284,000 ambulatory care visits in 2007; and it is estimated that this condition will be either directly or indirectly responsible for $76.6 billion in health care costs in 2010.9 The morbidity and mortality associated with uncontrolled hypertension make initiatives to improve the quality of care in this area important in any outpatient practice.
A newly employed critical care nurse was just about to finish a 12 hour night shift when she realized she had one more patient to administer medication to. It was the busiest Friday night shift she has ever worked due to poor nurse-patient ratio, and the workload felt impossible. She gave her last patient the properly prescribed medication, but failed to notice that the physician hastily wrote an updated dosage for a high risk medication, Digoxin. The patient’s heart rate began to slow down and life-saving procedures had to be activated. Medication errors are “any preventable event that may cause, or lead, to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer
Patients who refused to visit the practice, patients who declined to admit that their high blood pressure was secondary to their refusal to take their losartan. Luckily, my provider had been seeing these people for many years, and knew the techniques that would yield in the greatest cooperation. As I watched and listened, I obtained a deep understanding of the value of a relationship between the patient and the provider. Where one might have struggled to gain patient compliance, my provider knew when to implement a stern tone, and when to dial it back and become more comforting.
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.
With the increased cost of manufacturing, pharmaceutical companies have been divesting in their smaller or less profit making operations and focus on large segments. Many Pharmaceutical companies sold their manufacturing sites to contract manufacturing organizations. The dynamics of interfacing with contract manufacturing organization added intricacy in pharmaceutical supply chain network of pharmaceutical companies.
There were many ethical issues within this case; the first indication of an ethical problem was the administration of an incorrect medication to the patient. The doctor, administration, and providers involved in the care of the patient must decide what is ethically moral when informing the patient. I believe that it is the patient’s right to know that she received the wrong medication for a number of days. Although no major medical consequences occurred, I believe this
Standards of practice for LTCP have evolved over several decades in response to a complex set of Federal and state regulations governing the provision of prescription drugs in the LTC setting (CMS, 2014). The law that regulates the practice of pharmacy in nursing facilities are developed to safeguard the health and well being of nursing facility residents. This group of population have atypical care needs that would require alternative forms of medication or more intensive medication management. Federal law regulation mandates LTC facility in conjunction with LTCP to develop a system to decrease medication errors and adverse drug events; assure proper medication selection; monitor drug interactions; assess for over-medication, and under- medication; improve medication documentation (CMS, 2014). In order to be compliance with the federal law, it is imperative that the pharmacy and nursing facility work collaboratively to develop policy and procedure that meet the regulations.
Medications are important part of patient’s life, in that without compliance or adherence to once prescribed medication, the patient’s disease will linger on and cause more complications in their body. Medication compliance is one of the most important topics discussed with the patients. Medication compliance has been described as the ability of the patient to follow correctly prescribed medication. Compliance of medication does not only point out prescription drugs but any therapeutic and medical equipment such as spacers, braces, crutches walkers among others recommended by the physician or nurse practitioner. Medication adherence also addresses the correct prescribed dose of the medication. Ideally, patients