Taking too many meds? Here are some of the ways we can help
Posted by Eamonn Brady on
Actions taken by pharmacists at Whelehans to reduce Polypharmacy (over prescribing of medicines) for patients.
Part 1
Reducing polypharmacy for patients requires a comprehensive approach by pharmacists. Here are key actions that our pharmacists at Whelehans during med reviews to review overuse of medicines for both nursing home and non-nursing home patients. What Whelehans Pharmacists to tackle polypharmacy. I have split this up into ten areas I feel are important to reduce polypharmacy.
1. Conduct Regular Medication Reviews
Regularly review residents' medication regimens for appropriateness, efficacy, safety, and necessity. Assess for potential drug-drug or drug-disease interactions and duplicate therapies.
How Whelehans currently conduct Medicine reviews.
Whelehans conduct Comprehensive Medication Reviews every 3 months at each nursing home we supply medication to. These medication reviews are completed by the pharmacist in conjunction with the head nurse (usually Clinical Nurse Manager at each home). We offer this for non-nursing home patients in our two pharmacies too.
2. Deprescribing
Identify medications that can be safely discontinued or tapered, especially those with limited benefits or high risks in older adults. Collaborate with prescribers to implement deprescribing protocols.
3. Promote Evidence-Based Prescribing
Encourage the use of evidence-based guidelines tailored to geriatric patients. Recommend alternatives with lower risk profiles when possible.
How Whelehans currently Promote Evidence-Based Prescribing
The Whelehans Pharmacist uses his/her clinical knowledge to advise on this area, both in relation to possible side effects, interactions as well as advice where medicine doses are too low. Our pharmacists find a lot of patients prescribed starting doses of medicines like Donepezil (5mg. instead of recommended maintenance of 10mg) or Memantine (20mg maintenance dose instead of lesser dose like 10mg) simply because the GP did not have an opportunity to review after hospital discharge. Quite often, if the patient’s dementia is very advanced, the like of Donepezil and Memantine no longer have an effect (they slow down progression only) so should be considered for discontinuation so pharmacist will advise on this.
In nursing homes during medicine review, the Whelehans pharmacist asks the nurse about patients potential health issues which could match side effects of medicines like drowsiness which could be due to too high a dose of sedatives/ anti-psychotics, constipation which could be caused by the like of anti-cholinergic (or too high a dose of anti-cholinergic drugs), cognitive impairment which may not be explained by the patient medical condition like stroke or dementia but could be due to too high sedatives doses, bruising which could be a sign of too high blood thinner doses and so on. We ask the same questions to patients/ carers for non nursing home patients.
The issue with patients leaving hospitals, we do find over prescribing an issue in many cases (not always the hospital’s fault as many patients enter hospital with a polypharmacy issue), and for patients who were previously patients of Whelehans (i.e. Were in nursing home prior to hospital admission), Whelehans can question the prescribing choices made (with Senokot seemingly added by default); however this is a challenge for new nursing home admission direct from hospital to the nursing home (New to Whelehans) despite the hospital (in most cases) recording the changes on the prescription plus we can compare to previous GP prescriptions for same patient to try to determine unnecessary prescribing or possible prescribing errors
4. Collaborate with the Healthcare Team
Participate in interdisciplinary team meetings to discuss patient care plans. Provide education to prescribers, nurses, and caregivers about medication risks and benefits in older adults.
How Whelehans current medication management training for nurses:
Whelehans completes medication training for nursing homes and has a timetable for each nursing home to get nurses to undergo the training by the Whelehans pharmacist (sometime via Zoom)
To be continued next week
For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore). Email queries to info@whelehans.ie. Find us on Facebook.