What to look for when doing a medication\nreview?<\/h2>\n\n\n\n- Is the medication prescribed backed by evidenced-based research?<\/li>
- Are there any allergies to the medication?<\/li>
- Dosing of the medication at the right dose? Subtherapeutic or supratherapeutic dosing?<\/li>
- Any documented adverse reactions to the medications by staff<\/li>
- Is the drug effective?<\/li>
- Is there any duplicate therapy? Could one of the medications be stopped?<\/li>
- Drug interactions with other prescribed medications?<\/li><\/ul>\n\n\n\n
You will need to look at the\nentire picture and for what they are being treated. You’re not just looking at\nthe disease state; you are looking at the total body.<\/p>\n\n\n\n
When performing\na medication review, make sure to make a comparison of past and present\nmedications. <\/strong><\/p>\n\n\n\n
Comparing\npast and present medications is especially important when the resident is being\nreadmitted to the nursing home.<\/strong><\/p>\n\n\n\n
Perform a\nthorough review of all medications the patient will be taking while at the\nfacility. While doing this, you want to look for adverse reactions to other\nmedicines, natural products (vitamins homeopathic, herbal products), and OTC\nmedications.<\/strong><\/p>\n\n\n\n
Many patients do not realize there\ncan be interactions between their medications and over the counter\npreparations. It is our job as providers to look for these interactions and\nmake changes when needed.<\/p>\n\n\n\n
Was the patient previously on a\nstatin? Why was the medication discontinued? If the change in medications is an\nimprovement in medication regimen, then document and move on. <\/p>\n\n\n\n
However, if the patient would\nbenefit from not prescribing the medication, it is ok to get rid of the\nmedicine.<\/p>\n\n\n\n
There have been studies that\nshowed that after a medication reduction, only 10% of the population required\nthe medications to be reinstated.<\/p>\n\n\n\n
Now is the time to attempt to reduce the medication burden the patient may experience. Focus your attention on lowering protein pump inhibitors, statins, pain medications, benzodiazepines, antipsychotics, and over the counter medications. <\/p>\n\n\n\n
Here is a link to some of the most common medications in nursing homes<\/a>.<\/p>\n\n\n\n
Clinically significant Medication issues<\/h2>\n\n\n\nThe nurses in the homes are\nrequired to report any clinically significant medication issues to a medical\nprovider. Medication issues include changes to the patient’s physical, mental,\nand psychosocial wellbeing. <\/p>\n\n\n\n
If there are any adverse changes\nafter taking the medication, the nurse reports to the provider. Some action\nmust be taken by the provider but this doesn’t mean that the drug will be\ndiscontinued. However, it could result in a dose reduction or some other\nchange.<\/p>\n\n\n\n
With the PDPM payment model, the\nfacilities must report these changes by midnight of the next calendar day.\nHowever, we hope the nursing staff would report adverse reactions sooner so\nthat corrective action can be taken.<\/p>\n\n\n\n
When you receive these updates of\nadverse wellbeing, you should use this as an opportunity to reduce medications.\nThe medications the patient prescribed is often a cause of the adverse\nreactions they may be having.<\/p>\n\n\n\n\n
<\/div>\n\n\n\n\nCommunication between provider<\/h2>\n\n\n\nWhen performing the medication\nreview, if the attending or nurse practitioner identifies issues with\nmedications prescribed by a specialist, they are required to correct the\nmedication. Communication can be done by updating the specialist via:<\/p>\n\n\n\n
- Phone<\/li>
- Fax <\/li>
- Secure email<\/li>
- HIPPA\ncompliant text <\/li><\/ol>\n\n\n\n
Care should be taken so that the\npatient doesn’t receive a harmful medication before clarification of the\nprescription. Either place the medication on hold or discontinue the medication\nwhile waiting on the correction of drugs.<\/p>\n\n\n\n
If having a delay in medication would cause harm, then determine whether to continue the drug while waiting or consult another medical professional.<\/p>\n\n\n\n
There are ways to improve communication in the nursing home. Here is a link to an article discussing how to improve communication between nurses, doctors, physician assistants, and advanced nurse practitioners<\/a>. <\/p>\n\n\n\n
Factors to consider with medications in the\nelderly<\/h2>\n\n\n\n- A\nproportional increase in body fat relative to skeletal muscle with aging<\/li>
- Decreased drug\nclearance may result from the natural decline in renal function with age<\/li>
- Increasing\nage may result in an increased sensitivity to the effects of certain drugs<\/li>
- Hepatic\nfunction declines with advancing age. Age-related changes in hepatic function\nmay result in variability in drug metabolism <\/li>
- Use of herbal\nor dietary supplements has increased in the elderly<\/li><\/ol>\n\n\n\n
Medication reduction to improve nursing med\npass<\/h2>\n\n\n\n
Not only are all the meds\npotentially harmful to the patient, but they are also labor-intensive for the\nnurses in the facility. There may be opportunities when making dose reductions\nto improve the nursing pass. <\/p>\n\n\n\n
Some ways to\nimprove the med pass for the nurses include:<\/strong><\/h4>\n\n\n\n- Avoid\nordering medications that are given during mealtimes<\/li>
- Try to\nutilize once-daily dosing of medications when possible.<\/li>
- Eliminate all\nthe long-term vitamins like multivitamins, zinc, and vitamin C. There are\nmedically necessary vitamins such as vitamins D and B12. Still, you should test\nthe levels for these vitamins to see if they are required.<\/li>
- Discontinue\nmeds that are not needed. By making medication reductions for your residents,\nyou not only help your patient, but you will also improve the day of your\nnurses in the facilities.<\/li>
- Try not to\norder medications at specific times. Writing timing such as “BID or\nQD.” This will allow the nurse to schedule the times of the medicines to\nbe administered at appropriate times. This doesn’t apply to medications that\nneed to be separated by a certain number of hours like antibiotics. Also, if\nyou know that prescribing at a particular time will benefit the nurse or\npatient, then write the time.<\/li>
- Try to\nconsolidate medication passes so that medications are given together during the\nsame medication pass. However, show caution with patients that have difficulty\nwith a more substantial pill burden.<\/li>
- If you can\neliminate the 5 pm medication time, it will improve the speed of the nurses to\nadminister medications. They won’t have to interrupt the mealtimes of the\nresident.<\/li>
- Identify\nmedications that are being inappropriately dosed more or less frequently like\nLantus and combine them into once-daily dosing. Another common mistake is\nmetoprolol tartrate vs. succinate, which is commonly inputted incorrectly in\nthe medical record. If possible, change the tartrate to succinate to allow for\nonce-daily dosing.<\/li>
- Change PRN\nmedications to scheduled when the patient is utilizing the drugs regularly. For\nexample, if a patient takes the same pain medication every night at 8 pm, then\nrecord the medication for that time. You can schedule follow-ups in the future\nto see if this medication can be discontinued or the dose reduced. <\/li>
- Incorporate\nthe nurses in the process of medication reductions. Ask them to identify\npatients who may have QID blood sugar checks with insulin coverage. If they are\ncontrolled or even if they are running high consistently, ask the nurses to\nidentify them so that you can change the insulin doses as appropriate. <\/li><\/ol>\n\n\n\n
Psychotropic drugs<\/h2>\n\n\n\n
“Antipsychotics have only\nlimited efficacy for treatment of neuropsychiatric symptoms in patients with\ndementia but are associated with considerable side effects such as accelerated\ncognitive decline, risk of stroke, and death.”<\/p>\n\n\n\n
There are currently goals to reduce off-label use of antipsychotics in nursing homes. One way to reduce their use is to communicate with the nurses to identify opportunities for reduction. Are the patients showing benefits or negatives from being on these medications? <\/p>\n\n\n\n
Gradual dose reductions must be\nattempted on all residents taking antipsychotics. When new patients arrive at\nthe nursing home, you should analyze the need for these medications. <\/p>\n\n\n\n
Work with the psych APRN in the\nfacility or facility psychiatrist when ordering dose reductions. When possible,\nlet them handle the reduction in medications. If they are not performing the\nmodifications, care should be taken to reduce medications when possible. <\/p>\n\n\n\n
One of the most important things\nto aid in the effectiveness of reducing antipsychotic use was the education of\nstaff at every level of the organization. <\/p>\n\n\n\n
Barriers to medication\nreduction initiatives<\/h2>\n\n\n\n- Family resistance to recommendations to reduce or D\/C medications<\/li>
- Aversion of staff to get rid of or reduce medications<\/li>
- Lack of effectiveness and\/or lack of staff resources <\/li>
- Worries about the return of symptoms or behaviors <\/li>
- Lack of nonpharmacological management strategies<\/li><\/ul>\n\n\n\n
Certain medications have a\nperceived value to the nursing home. For instance, the use of antipsychotics\nmay temporarily sedate patients. However, the increased risks of falls and\ncognitive decline can outweigh their benefits. Dosing reductions of\nantipsychotics may result in more work for the staff.<\/p>\n\n\n\n
Families will need education regarding the risks of certain medications and their long-term use. By educating the family that a PPI can be harmful if used for extended periods may allow them to process the benefit to the resident.<\/p>\n\n\n\n
Staff and families may worry that\nreducing diabetic medications or antihypertensives will result in adverse\nreactions. They need to be educated about the risks of certain medicines\noutweighing the benefit. Drugs like glipizide have increased the chance of\nhypoglycemia, and beta-blockers have side effect profiles as well.<\/p>\n\n\n\n
Conclusion<\/h2>\n\n\n\n
Medication reduction is made for\nthe safety of the residents and the improvement of medication med pass for the\nnurses in the nursing home. There will be many opportunities for medication\nreduction. <\/p>\n\n\n\n
You should always be looking for\nways to reduce medications when appropriate. When patients arrive at the\nfacility, sick visits, annual exams, 60-day regulatory visits, and discharge\nvisits should all time to review medications.<\/p>\n\n\n\n
Medication reduction is a team effort and should be something that all medical providers work towards. It is for the safety of the residents and improvement in their health.\u00a0<\/p>\n\n\n\n\n![\"Dragon](\"https:\/\/www.tqlkg.com\/image-100291805-10586061\")
You will need to look at the\nentire picture and for what they are being treated. You’re not just looking at\nthe disease state; you are looking at the total body.<\/p>\n\n\n\n
When performing\na medication review, make sure to make a comparison of past and present\nmedications. <\/strong><\/p>\n\n\n\n
Comparing\npast and present medications is especially important when the resident is being\nreadmitted to the nursing home.<\/strong><\/p>\n\n\n\n
Perform a\nthorough review of all medications the patient will be taking while at the\nfacility. While doing this, you want to look for adverse reactions to other\nmedicines, natural products (vitamins homeopathic, herbal products), and OTC\nmedications.<\/strong><\/p>\n\n\n\n
Many patients do not realize there\ncan be interactions between their medications and over the counter\npreparations. It is our job as providers to look for these interactions and\nmake changes when needed.<\/p>\n\n\n\n
Was the patient previously on a\nstatin? Why was the medication discontinued? If the change in medications is an\nimprovement in medication regimen, then document and move on. <\/p>\n\n\n\n
However, if the patient would\nbenefit from not prescribing the medication, it is ok to get rid of the\nmedicine.<\/p>\n\n\n\n
There have been studies that\nshowed that after a medication reduction, only 10% of the population required\nthe medications to be reinstated.<\/p>\n\n\n\n
Now is the time to attempt to reduce the medication burden the patient may experience. Focus your attention on lowering protein pump inhibitors, statins, pain medications, benzodiazepines, antipsychotics, and over the counter medications. <\/p>\n\n\n\n
Here is a link to some of the most common medications in nursing homes<\/a>.<\/p>\n\n\n\n
Clinically significant Medication issues<\/h2>\n\n\n\nThe nurses in the homes are\nrequired to report any clinically significant medication issues to a medical\nprovider. Medication issues include changes to the patient’s physical, mental,\nand psychosocial wellbeing. <\/p>\n\n\n\n
If there are any adverse changes\nafter taking the medication, the nurse reports to the provider. Some action\nmust be taken by the provider but this doesn’t mean that the drug will be\ndiscontinued. However, it could result in a dose reduction or some other\nchange.<\/p>\n\n\n\n
With the PDPM payment model, the\nfacilities must report these changes by midnight of the next calendar day.\nHowever, we hope the nursing staff would report adverse reactions sooner so\nthat corrective action can be taken.<\/p>\n\n\n\n
When you receive these updates of\nadverse wellbeing, you should use this as an opportunity to reduce medications.\nThe medications the patient prescribed is often a cause of the adverse\nreactions they may be having.<\/p>\n\n\n\n\n
<\/div>\n\n\n\n\nCommunication between provider<\/h2>\n\n\n\nWhen performing the medication\nreview, if the attending or nurse practitioner identifies issues with\nmedications prescribed by a specialist, they are required to correct the\nmedication. Communication can be done by updating the specialist via:<\/p>\n\n\n\n
- Phone<\/li>
- Fax <\/li>
- Secure email<\/li>
- HIPPA\ncompliant text <\/li><\/ol>\n\n\n\n
Care should be taken so that the\npatient doesn’t receive a harmful medication before clarification of the\nprescription. Either place the medication on hold or discontinue the medication\nwhile waiting on the correction of drugs.<\/p>\n\n\n\n
If having a delay in medication would cause harm, then determine whether to continue the drug while waiting or consult another medical professional.<\/p>\n\n\n\n
There are ways to improve communication in the nursing home. Here is a link to an article discussing how to improve communication between nurses, doctors, physician assistants, and advanced nurse practitioners<\/a>. <\/p>\n\n\n\n
Factors to consider with medications in the\nelderly<\/h2>\n\n\n\n- A\nproportional increase in body fat relative to skeletal muscle with aging<\/li>
- Decreased drug\nclearance may result from the natural decline in renal function with age<\/li>
- Increasing\nage may result in an increased sensitivity to the effects of certain drugs<\/li>
- Hepatic\nfunction declines with advancing age. Age-related changes in hepatic function\nmay result in variability in drug metabolism <\/li>
- Use of herbal\nor dietary supplements has increased in the elderly<\/li><\/ol>\n\n\n\n
Medication reduction to improve nursing med\npass<\/h2>\n\n\n\n
Not only are all the meds\npotentially harmful to the patient, but they are also labor-intensive for the\nnurses in the facility. There may be opportunities when making dose reductions\nto improve the nursing pass. <\/p>\n\n\n\n
Some ways to\nimprove the med pass for the nurses include:<\/strong><\/h4>\n\n\n\n- Avoid\nordering medications that are given during mealtimes<\/li>
- Try to\nutilize once-daily dosing of medications when possible.<\/li>
- Eliminate all\nthe long-term vitamins like multivitamins, zinc, and vitamin C. There are\nmedically necessary vitamins such as vitamins D and B12. Still, you should test\nthe levels for these vitamins to see if they are required.<\/li>
- Discontinue\nmeds that are not needed. By making medication reductions for your residents,\nyou not only help your patient, but you will also improve the day of your\nnurses in the facilities.<\/li>
- Try not to\norder medications at specific times. Writing timing such as “BID or\nQD.” This will allow the nurse to schedule the times of the medicines to\nbe administered at appropriate times. This doesn’t apply to medications that\nneed to be separated by a certain number of hours like antibiotics. Also, if\nyou know that prescribing at a particular time will benefit the nurse or\npatient, then write the time.<\/li>
- Try to\nconsolidate medication passes so that medications are given together during the\nsame medication pass. However, show caution with patients that have difficulty\nwith a more substantial pill burden.<\/li>
- If you can\neliminate the 5 pm medication time, it will improve the speed of the nurses to\nadminister medications. They won’t have to interrupt the mealtimes of the\nresident.<\/li>
- Identify\nmedications that are being inappropriately dosed more or less frequently like\nLantus and combine them into once-daily dosing. Another common mistake is\nmetoprolol tartrate vs. succinate, which is commonly inputted incorrectly in\nthe medical record. If possible, change the tartrate to succinate to allow for\nonce-daily dosing.<\/li>
- Change PRN\nmedications to scheduled when the patient is utilizing the drugs regularly. For\nexample, if a patient takes the same pain medication every night at 8 pm, then\nrecord the medication for that time. You can schedule follow-ups in the future\nto see if this medication can be discontinued or the dose reduced. <\/li>
- Incorporate\nthe nurses in the process of medication reductions. Ask them to identify\npatients who may have QID blood sugar checks with insulin coverage. If they are\ncontrolled or even if they are running high consistently, ask the nurses to\nidentify them so that you can change the insulin doses as appropriate. <\/li><\/ol>\n\n\n\n
Psychotropic drugs<\/h2>\n\n\n\n
“Antipsychotics have only\nlimited efficacy for treatment of neuropsychiatric symptoms in patients with\ndementia but are associated with considerable side effects such as accelerated\ncognitive decline, risk of stroke, and death.”<\/p>\n\n\n\n
There are currently goals to reduce off-label use of antipsychotics in nursing homes. One way to reduce their use is to communicate with the nurses to identify opportunities for reduction. Are the patients showing benefits or negatives from being on these medications? <\/p>\n\n\n\n
Gradual dose reductions must be\nattempted on all residents taking antipsychotics. When new patients arrive at\nthe nursing home, you should analyze the need for these medications. <\/p>\n\n\n\n
Work with the psych APRN in the\nfacility or facility psychiatrist when ordering dose reductions. When possible,\nlet them handle the reduction in medications. If they are not performing the\nmodifications, care should be taken to reduce medications when possible. <\/p>\n\n\n\n
One of the most important things\nto aid in the effectiveness of reducing antipsychotic use was the education of\nstaff at every level of the organization. <\/p>\n\n\n\n
Barriers to medication\nreduction initiatives<\/h2>\n\n\n\n- Family resistance to recommendations to reduce or D\/C medications<\/li>
- Aversion of staff to get rid of or reduce medications<\/li>
- Lack of effectiveness and\/or lack of staff resources <\/li>
- Worries about the return of symptoms or behaviors <\/li>
- Lack of nonpharmacological management strategies<\/li><\/ul>\n\n\n\n
Certain medications have a\nperceived value to the nursing home. For instance, the use of antipsychotics\nmay temporarily sedate patients. However, the increased risks of falls and\ncognitive decline can outweigh their benefits. Dosing reductions of\nantipsychotics may result in more work for the staff.<\/p>\n\n\n\n
Families will need education regarding the risks of certain medications and their long-term use. By educating the family that a PPI can be harmful if used for extended periods may allow them to process the benefit to the resident.<\/p>\n\n\n\n
Staff and families may worry that\nreducing diabetic medications or antihypertensives will result in adverse\nreactions. They need to be educated about the risks of certain medicines\noutweighing the benefit. Drugs like glipizide have increased the chance of\nhypoglycemia, and beta-blockers have side effect profiles as well.<\/p>\n\n\n\n
Conclusion<\/h2>\n\n\n\n
Medication reduction is made for\nthe safety of the residents and the improvement of medication med pass for the\nnurses in the nursing home. There will be many opportunities for medication\nreduction. <\/p>\n\n\n\n
You should always be looking for\nways to reduce medications when appropriate. When patients arrive at the\nfacility, sick visits, annual exams, 60-day regulatory visits, and discharge\nvisits should all time to review medications.<\/p>\n\n\n\n
Medication reduction is a team effort and should be something that all medical providers work towards. It is for the safety of the residents and improvement in their health.\u00a0<\/p>\n\n\n\n\n
Communication between provider<\/h2>\n\n\n\nWhen performing the medication\nreview, if the attending or nurse practitioner identifies issues with\nmedications prescribed by a specialist, they are required to correct the\nmedication. Communication can be done by updating the specialist via:<\/p>\n\n\n\n
- Phone<\/li>
- Fax <\/li>
- Secure email<\/li>
- HIPPA\ncompliant text <\/li><\/ol>\n\n\n\n
Care should be taken so that the\npatient doesn’t receive a harmful medication before clarification of the\nprescription. Either place the medication on hold or discontinue the medication\nwhile waiting on the correction of drugs.<\/p>\n\n\n\n
If having a delay in medication would cause harm, then determine whether to continue the drug while waiting or consult another medical professional.<\/p>\n\n\n\n
There are ways to improve communication in the nursing home. Here is a link to an article discussing how to improve communication between nurses, doctors, physician assistants, and advanced nurse practitioners<\/a>. <\/p>\n\n\n\n
Factors to consider with medications in the\nelderly<\/h2>\n\n\n\n- A\nproportional increase in body fat relative to skeletal muscle with aging<\/li>
- Decreased drug\nclearance may result from the natural decline in renal function with age<\/li>
- Increasing\nage may result in an increased sensitivity to the effects of certain drugs<\/li>
- Hepatic\nfunction declines with advancing age. Age-related changes in hepatic function\nmay result in variability in drug metabolism <\/li>
- Use of herbal\nor dietary supplements has increased in the elderly<\/li><\/ol>\n\n\n\n
Medication reduction to improve nursing med\npass<\/h2>\n\n\n\n
Not only are all the meds\npotentially harmful to the patient, but they are also labor-intensive for the\nnurses in the facility. There may be opportunities when making dose reductions\nto improve the nursing pass. <\/p>\n\n\n\n
Some ways to\nimprove the med pass for the nurses include:<\/strong><\/h4>\n\n\n\n- Avoid\nordering medications that are given during mealtimes<\/li>
- Try to\nutilize once-daily dosing of medications when possible.<\/li>
- Eliminate all\nthe long-term vitamins like multivitamins, zinc, and vitamin C. There are\nmedically necessary vitamins such as vitamins D and B12. Still, you should test\nthe levels for these vitamins to see if they are required.<\/li>
- Discontinue\nmeds that are not needed. By making medication reductions for your residents,\nyou not only help your patient, but you will also improve the day of your\nnurses in the facilities.<\/li>
- Try not to\norder medications at specific times. Writing timing such as “BID or\nQD.” This will allow the nurse to schedule the times of the medicines to\nbe administered at appropriate times. This doesn’t apply to medications that\nneed to be separated by a certain number of hours like antibiotics. Also, if\nyou know that prescribing at a particular time will benefit the nurse or\npatient, then write the time.<\/li>
- Try to\nconsolidate medication passes so that medications are given together during the\nsame medication pass. However, show caution with patients that have difficulty\nwith a more substantial pill burden.<\/li>
- If you can\neliminate the 5 pm medication time, it will improve the speed of the nurses to\nadminister medications. They won’t have to interrupt the mealtimes of the\nresident.<\/li>
- Identify\nmedications that are being inappropriately dosed more or less frequently like\nLantus and combine them into once-daily dosing. Another common mistake is\nmetoprolol tartrate vs. succinate, which is commonly inputted incorrectly in\nthe medical record. If possible, change the tartrate to succinate to allow for\nonce-daily dosing.<\/li>
- Change PRN\nmedications to scheduled when the patient is utilizing the drugs regularly. For\nexample, if a patient takes the same pain medication every night at 8 pm, then\nrecord the medication for that time. You can schedule follow-ups in the future\nto see if this medication can be discontinued or the dose reduced. <\/li>
- Incorporate\nthe nurses in the process of medication reductions. Ask them to identify\npatients who may have QID blood sugar checks with insulin coverage. If they are\ncontrolled or even if they are running high consistently, ask the nurses to\nidentify them so that you can change the insulin doses as appropriate. <\/li><\/ol>\n\n\n\n
Psychotropic drugs<\/h2>\n\n\n\n
“Antipsychotics have only\nlimited efficacy for treatment of neuropsychiatric symptoms in patients with\ndementia but are associated with considerable side effects such as accelerated\ncognitive decline, risk of stroke, and death.”<\/p>\n\n\n\n
There are currently goals to reduce off-label use of antipsychotics in nursing homes. One way to reduce their use is to communicate with the nurses to identify opportunities for reduction. Are the patients showing benefits or negatives from being on these medications? <\/p>\n\n\n\n
Gradual dose reductions must be\nattempted on all residents taking antipsychotics. When new patients arrive at\nthe nursing home, you should analyze the need for these medications. <\/p>\n\n\n\n
Work with the psych APRN in the\nfacility or facility psychiatrist when ordering dose reductions. When possible,\nlet them handle the reduction in medications. If they are not performing the\nmodifications, care should be taken to reduce medications when possible. <\/p>\n\n\n\n
One of the most important things\nto aid in the effectiveness of reducing antipsychotic use was the education of\nstaff at every level of the organization. <\/p>\n\n\n\n
Care should be taken so that the\npatient doesn’t receive a harmful medication before clarification of the\nprescription. Either place the medication on hold or discontinue the medication\nwhile waiting on the correction of drugs.<\/p>\n\n\n\n
If having a delay in medication would cause harm, then determine whether to continue the drug while waiting or consult another medical professional.<\/p>\n\n\n\n
There are ways to improve communication in the nursing home. Here is a link to an article discussing how to improve communication between nurses, doctors, physician assistants, and advanced nurse practitioners<\/a>. <\/p>\n\n\n\n
Factors to consider with medications in the\nelderly<\/h2>\n\n\n\n- A\nproportional increase in body fat relative to skeletal muscle with aging<\/li>
- Decreased drug\nclearance may result from the natural decline in renal function with age<\/li>
- Increasing\nage may result in an increased sensitivity to the effects of certain drugs<\/li>
- Hepatic\nfunction declines with advancing age. Age-related changes in hepatic function\nmay result in variability in drug metabolism <\/li>
- Use of herbal\nor dietary supplements has increased in the elderly<\/li><\/ol>\n\n\n\n
Medication reduction to improve nursing med\npass<\/h2>\n\n\n\n
Not only are all the meds\npotentially harmful to the patient, but they are also labor-intensive for the\nnurses in the facility. There may be opportunities when making dose reductions\nto improve the nursing pass. <\/p>\n\n\n\n
Medication reduction to improve nursing med\npass<\/h2>\n\n\n\n
Not only are all the meds\npotentially harmful to the patient, but they are also labor-intensive for the\nnurses in the facility. There may be opportunities when making dose reductions\nto improve the nursing pass. <\/p>\n\n\n\n
Some ways to\nimprove the med pass for the nurses include:<\/strong><\/h4>\n\n\n\n- Avoid\nordering medications that are given during mealtimes<\/li>
- Try to\nutilize once-daily dosing of medications when possible.<\/li>
- Eliminate all\nthe long-term vitamins like multivitamins, zinc, and vitamin C. There are\nmedically necessary vitamins such as vitamins D and B12. Still, you should test\nthe levels for these vitamins to see if they are required.<\/li>
- Discontinue\nmeds that are not needed. By making medication reductions for your residents,\nyou not only help your patient, but you will also improve the day of your\nnurses in the facilities.<\/li>
- Try not to\norder medications at specific times. Writing timing such as “BID or\nQD.” This will allow the nurse to schedule the times of the medicines to\nbe administered at appropriate times. This doesn’t apply to medications that\nneed to be separated by a certain number of hours like antibiotics. Also, if\nyou know that prescribing at a particular time will benefit the nurse or\npatient, then write the time.<\/li>
- Try to\nconsolidate medication passes so that medications are given together during the\nsame medication pass. However, show caution with patients that have difficulty\nwith a more substantial pill burden.<\/li>
- If you can\neliminate the 5 pm medication time, it will improve the speed of the nurses to\nadminister medications. They won’t have to interrupt the mealtimes of the\nresident.<\/li>
- Identify\nmedications that are being inappropriately dosed more or less frequently like\nLantus and combine them into once-daily dosing. Another common mistake is\nmetoprolol tartrate vs. succinate, which is commonly inputted incorrectly in\nthe medical record. If possible, change the tartrate to succinate to allow for\nonce-daily dosing.<\/li>
- Change PRN\nmedications to scheduled when the patient is utilizing the drugs regularly. For\nexample, if a patient takes the same pain medication every night at 8 pm, then\nrecord the medication for that time. You can schedule follow-ups in the future\nto see if this medication can be discontinued or the dose reduced. <\/li>
- Incorporate\nthe nurses in the process of medication reductions. Ask them to identify\npatients who may have QID blood sugar checks with insulin coverage. If they are\ncontrolled or even if they are running high consistently, ask the nurses to\nidentify them so that you can change the insulin doses as appropriate. <\/li><\/ol>\n\n\n\n
Psychotropic drugs<\/h2>\n\n\n\n
“Antipsychotics have only\nlimited efficacy for treatment of neuropsychiatric symptoms in patients with\ndementia but are associated with considerable side effects such as accelerated\ncognitive decline, risk of stroke, and death.”<\/p>\n\n\n\n
There are currently goals to reduce off-label use of antipsychotics in nursing homes. One way to reduce their use is to communicate with the nurses to identify opportunities for reduction. Are the patients showing benefits or negatives from being on these medications? <\/p>\n\n\n\n
Gradual dose reductions must be\nattempted on all residents taking antipsychotics. When new patients arrive at\nthe nursing home, you should analyze the need for these medications. <\/p>\n\n\n\n
Work with the psych APRN in the\nfacility or facility psychiatrist when ordering dose reductions. When possible,\nlet them handle the reduction in medications. If they are not performing the\nmodifications, care should be taken to reduce medications when possible. <\/p>\n\n\n\n
One of the most important things\nto aid in the effectiveness of reducing antipsychotic use was the education of\nstaff at every level of the organization. <\/p>\n\n\n\n
Psychotropic drugs<\/h2>\n\n\n\n
“Antipsychotics have only\nlimited efficacy for treatment of neuropsychiatric symptoms in patients with\ndementia but are associated with considerable side effects such as accelerated\ncognitive decline, risk of stroke, and death.”<\/p>\n\n\n\n
There are currently goals to reduce off-label use of antipsychotics in nursing homes. One way to reduce their use is to communicate with the nurses to identify opportunities for reduction. Are the patients showing benefits or negatives from being on these medications? <\/p>\n\n\n\n
Gradual dose reductions must be\nattempted on all residents taking antipsychotics. When new patients arrive at\nthe nursing home, you should analyze the need for these medications. <\/p>\n\n\n\n
Work with the psych APRN in the\nfacility or facility psychiatrist when ordering dose reductions. When possible,\nlet them handle the reduction in medications. If they are not performing the\nmodifications, care should be taken to reduce medications when possible. <\/p>\n\n\n\n
One of the most important things\nto aid in the effectiveness of reducing antipsychotic use was the education of\nstaff at every level of the organization. <\/p>\n\n\n\n
Barriers to medication\nreduction initiatives<\/h2>\n\n\n\n- Family resistance to recommendations to reduce or D\/C medications<\/li>
- Aversion of staff to get rid of or reduce medications<\/li>
- Lack of effectiveness and\/or lack of staff resources <\/li>
- Worries about the return of symptoms or behaviors <\/li>
- Lack of nonpharmacological management strategies<\/li><\/ul>\n\n\n\n
Certain medications have a\nperceived value to the nursing home. For instance, the use of antipsychotics\nmay temporarily sedate patients. However, the increased risks of falls and\ncognitive decline can outweigh their benefits. Dosing reductions of\nantipsychotics may result in more work for the staff.<\/p>\n\n\n\n
Families will need education regarding the risks of certain medications and their long-term use. By educating the family that a PPI can be harmful if used for extended periods may allow them to process the benefit to the resident.<\/p>\n\n\n\n
Staff and families may worry that\nreducing diabetic medications or antihypertensives will result in adverse\nreactions. They need to be educated about the risks of certain medicines\noutweighing the benefit. Drugs like glipizide have increased the chance of\nhypoglycemia, and beta-blockers have side effect profiles as well.<\/p>\n\n\n\n
Conclusion<\/h2>\n\n\n\n
Medication reduction is made for\nthe safety of the residents and the improvement of medication med pass for the\nnurses in the nursing home. There will be many opportunities for medication\nreduction. <\/p>\n\n\n\n
You should always be looking for\nways to reduce medications when appropriate. When patients arrive at the\nfacility, sick visits, annual exams, 60-day regulatory visits, and discharge\nvisits should all time to review medications.<\/p>\n\n\n\n
Medication reduction is a team effort and should be something that all medical providers work towards. It is for the safety of the residents and improvement in their health.\u00a0<\/p>\n\n\n\n\n
Certain medications have a\nperceived value to the nursing home. For instance, the use of antipsychotics\nmay temporarily sedate patients. However, the increased risks of falls and\ncognitive decline can outweigh their benefits. Dosing reductions of\nantipsychotics may result in more work for the staff.<\/p>\n\n\n\n
Families will need education regarding the risks of certain medications and their long-term use. By educating the family that a PPI can be harmful if used for extended periods may allow them to process the benefit to the resident.<\/p>\n\n\n\n
Staff and families may worry that\nreducing diabetic medications or antihypertensives will result in adverse\nreactions. They need to be educated about the risks of certain medicines\noutweighing the benefit. Drugs like glipizide have increased the chance of\nhypoglycemia, and beta-blockers have side effect profiles as well.<\/p>\n\n\n\n
Conclusion<\/h2>\n\n\n\n
Medication reduction is made for\nthe safety of the residents and the improvement of medication med pass for the\nnurses in the nursing home. There will be many opportunities for medication\nreduction. <\/p>\n\n\n\n
You should always be looking for\nways to reduce medications when appropriate. When patients arrive at the\nfacility, sick visits, annual exams, 60-day regulatory visits, and discharge\nvisits should all time to review medications.<\/p>\n\n\n\n
Medication reduction is a team effort and should be something that all medical providers work towards. It is for the safety of the residents and improvement in their health.\u00a0<\/p>\n\n\n\n\n
