Polypharm presentation

Polypharm presentation

• 1.
  Polypharmacy in Gerontology CassandraRodocker, Lauren Scarponi, Jessica Talbot, Lisa Tripp
• 2.
  Polypharmacy: The concurrent useof multiple medications (Mauk, 2014, p417)
• 3.
  The problem: Polypharmacy increases therisk of morbidity and mortality 30% 50% 41% Clients that have 2 or more physicians; resulting in polypharmacy Clients that are prescribed 5 or more medications 65 year olds admitted to hospital because of polypharmacy
• 4.
  Physiological Effects onOlder Adults Nonspecific Complaints (i.e. cognitive impairment, falls, decreased functional status, malaise, abdominal discomfort, nausea/vomiting, sleep changes, fatigue/weakness) caused by drug-drug interactions food-drug interactions disease-drug interactions drug toxicity Increased morbidity and mortality
• 5.
  The solution Education andDocumentation Clients should be encouraged to inform all of their doctors of all of their medications (or preferably, see only one doctor) Nurses and doctors should teach clients about what medications do, so clients can advocate for themselves
• 6.
  BEERS A ClinicalTool for Nurses
• 7.
  How it works:Beers catalogues medications that cause adverse drug events Step 1 Inappropriate drug choice Medications generally to be avoided in the elderly population Step 2 Excess dosage Medications at a dose or duration of therapy not to be exceeded Step 3 Drug-disease interaction Medications to be avoided for patients with specific co-morbid conditions
• 8.
  Category One: Inappropriatedrug choice Therapeutic/ Category Drug Long-acting benzodiazepines, including: diazepam (VALIUM) flurazepam (DALMANE) chlordiazepoxide (LIBRIUM) *all of which have long half-lives Recommendation AVOID Rationale This can lead to accumulation of the drug, leading to excessive sedation and an increase in the risk of falls and fractures
• 9.
  Category Two: ExcessDosage Therapeutic/ Category Drug Long-term use of stimulant laxatives bisacodyl (DULCOLAX) cascara sagrada (made from the dried bark of an American buckthorn) Recommendation AVOID may be appropriate in the presence of opiate analgesic use Rationale Medication may exacerbate bowel dysfunction
• 10.
  Category Three: Drug-diseaseinteraction Therapeutic/ Category Drug Pts with a hx of syncope (temporary loss of consciousness caused by a fall in BP) or falls receiving meds such as benzodiazepines and/or tricyclic antidepressants amitriptyline (ELAVIL) doxepin (SINEQUAN) imipramine (NORPRAMIN) Recommendation AVOID Rationale Medications may: Produce ataxia Impair psychomotor function Increase falls
• 11.
  Why do nursesneed BEERS? Nurses are the only members of the healthcare team that actually witness the client’s use and outcome of medications It is our job to advocate for our clients BEERS will help bridge the knowledge gap for clients about medications
• 12.
  Nursing Care Plan Assessment Assessthe patient for signs/symptoms of polypharmacy, review and reconcile patient medication lists, clarify the purpose and use of all medications. Diagnosis Drug toxicity/drug interaction r/t concurrent use of multiple medications manifested by cognitive/functional impairment, falls, malaise, abdominal complaints, etc. Plan Goal Patient will discontinue use of multiple concurrent medications and be actively involved in the process.
• 13.
  Nursing Care Plan Intervention Educatethe client about the active ingredients in their medications and additive effects of taking multiple meds with the same active ingredients Educate the client about only using one pharmacy and taking medications exactly as prescribed Educate the client about lifestyle changes that could ultimately eliminate the use of a drug Educate the client about the importance of reporting all medications to all doctors they visit Educate the client and family about the signs of trouble (see physiological signs of polypharmacy) and that such symptoms should be reported to their doctors immediately. Ask the patient to perform teach-back education: How they will take their medications When they should take their medications (and in what doses) Signs/symptoms of interactions and toxicity Evaluation
• 14.
  References American Geriatrics SocietyUpdated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. (2012). Journal of the American Geriatrics Society, 616-631. Fusco D., Lattanzio F., Tosato M., Corsonello A., Cherubini A., Volpato S, et al. (2009). Development of CRIteria to assess appropriate Medication use among Elderly complex patients. (CRIME) Project. Drugs Aging; 26 (Suppl. 1):S3–13. Kinsella K., Phillips D.R. (2005). Global aging: the challenge of success. Popul Bull; 60:3–42. Mauk, K. (2014). Gerontological nursing (3rd ed.). Sudbury, MA: Jones and Bartlett Publishers.