Drugs & Polypharmacy

Reduction in Polypharmacy is Beneficial for Both Nursing Home Residents and Health-Care Providers

June 13, 2013 | by Yeroushalmi Law

It is not uncommon for the elderly to need the assistance of multiple medications to maintain their health. However, as the number of medications being taken increases, so does the risk involved. A study conducted by the Division of Geriatric Medicine at the Saint Louis University School of Medicine finds that incorporating more inter-professional education in nursing home caretakers’ training can help reduce polypharmacy in their facilities. Such discovery is significant when it is taken into account that up to 28 percent of nursing home residents are hospitalized due to adverse drug reactions (ADR). An ADR’s mortality rate is significantly increased when the patient is taking over six medications.

The need to decrease polypharmacy is not only evident in residents’ high rate of hospitalizations, but it is also reflected in the incredible cost created by it. The study cites a cost analysis which proves that for every dollar spent on medications in nursing homes, another dollar and thirty three cents are spent on treating adverse drug reactions. It is abundantly clear that nursing facilities should have a greater interest in reducing polypharmacy in order to increase the quality of care of their residents, and to decrease the cost of care for themselves.

Enhancing communication amongst nurses, doctors, resident’s families, and staff can help them track the resident’s medications, and detect any deterioration due to polypharmacy. This allows for all those involved in the resident’s care to be more fully informed about how they can best help him or her. The study also suggests that hand counting all medications prescribed to patients from the physician’s order sheet is a more reliable way to avoid any mistakes from using an electronic log. Although this may seem more time consuming for pharmacists, it reduces the time spent on having to solve adverse drug reactions resulting from negative drug interactions later. Additionally, minimizing the number of medications prescribed also reduces medication administration time, which allows staff more time to dedicate to providing proper care and attention to each resident. Furthermore, a resident that is less medicated has a decreased risk for falls, weight-loss, and even death.

This new information-based initiative is simple and can only be made possible through the cooperation of pharmacists and nursing home staff. The Omnibus Budget Reconciliation Act of 1987 (OBRA) included a clause which demands that all certified nursing homes have pharmacy services available on location at their facilities. Therefore, all certified nursing homes already have an infrastructure of professionals which facilitates the spread of knowledge in order to promote a decrease in polypharmacy. There is also an incentive present for nursing homes to decrease medication use in order to save money and time, and increase the quality of care for their residents. This need to increase the quality of care of their residents should outweigh their desire for convenience. Sedating patients so that fewer staff is needed to care for them is a common practice at many nursing homes that value convenience over their residents’ well-being, and it constitutes a form of elder abuse.

Re-hospitalization of Nursing Home Residents Related to Licensed Nurse Retention

June 7, 2013 | by Yeroushalmi Law

It is no secret that taking care of the elderly in a nursing home is an incredibly important role that carries with it responsibilities of magnanimous proportions. In addition to offering physical aid to avoid falls and encourage mobility through physical exercises, nurses must also build rapport with their residents so that they may offer them emotional support through their caretaking process. However, the daily routine of caring for several residents often becomes exhausting for these nurses, leaving them burned out. Such exhaustion often results in a nurse leaving the facility and the relationships he or she has built with the residents. This common phenomenon among nursing home caretakers causes either a high turnover rate amongst nurses, or leaves the facility constantly understaffed.

A recent study published by The Gerontological Society of America explores the relationship that exists between nurse turnover and nursing home resident re-hospitalization. They find that many hospital readmissions may be prevented if the quality of nursing home care is improved through the hiring of more licensed nurses and licensed practical nurses. As it stands, they estimate that about 28% to a staggering 40% of re-hospitalizations may be avoided. In order to improve the quality of care, nursing homes must hire enough licensed nurses and keep them for long periods of time so that the care may be consistent. The study found that higher licensed nurse staffing correlated with lower licensed nurse turnover rates. More importantly this showed that increasing a nurse retention rate by 10% would reduce hospital readmission rates by 19%. This occurs because a long term stay at a nursing position fosters specialized knowledge which better equips nurses to provide a higher quality of care for residents.

In order to promote higher nurse retention rates in nursing homes, these facilities must invest time in constructing strategies to encourage long-term job retention. A nursing home’s priority must be to provide the highest quality of care to their residents. This includes ensuring that their residents’ needs to be hospitalized are minimized by maximizing the assistance they receive from professional nurses at the facility. In addition to the benefits conceded to residents from increasing nurse retention, there is also an economic incentive derived from it. Many nursing home administrators mistakenly believe that staff turnover is a money-saving strategy. However, nursing homes with higher performance levels on staff turnover, retention, and avoidable hospitalizations receive extra money from the CMS Nursing Home Value-Based Purchasing. Additionally, those that have an increased rate of Medicare hospital readmissions are actually sanctioned by receiving lower Medicare payments.

Polypharmacy is Linked to Increases of Adverse Effects in Nursing Homes

January 14, 2013 | by Yeroushalmi Law

A recent study in the Journal of American Medical Directors Association has proposed that the use of multiple medications on patients, sometimes for off-label purposes, is a significant practice in nursing homes and may lead to adverse drug effects such as falls and delirium. This practice is referred to as polypharmacy and is reportedly widespread in nursing homes across America, with as much as 40.3 % of residents being given inappropriate prescriptions.

The overuse of these medications is particularly prevalent among psychotropic drugs such as antidepressants and antipsychotics. According to the study, between 50 and 80 percent of nursing home residents are prescribed at least one psychotropic drug. The use of antidepressants has increased among older residents as well, with a reported 49% of US nursing home residents being administered these drugs. Antidepressants are known to cause a multitude of adverse affects such as serotonin syndrome, falls, hypnatremia, delirium, gastrointestinal bleeding, and osteoporosis.

Despite growing evidence of morbidity and mortality, antipsychotic drugs have become the dominant medication in treatments of behavioral and psychological symptoms of dementia. Recent surveys have found that 1 in 3 nursing home residents are treated with antipsychotics, even though the efficiency of antipsychotic drugs is limited, with estimates between only one in three to one in five patients demonstrating significant improvement. Furthermore, the use of antipsychotic medication has been known to trigger numerous side effects such as delirium and unhealthy weight gain. Chronic understaffing in nursing homes coupled with the extensive use of antipsychotic medication for off label purposes can lead to the chemical restraint of patients. This morally reprehensible activity is a violation of the Patients’ Rights.

A study from the US national home survey also reported that 53.8% of all nursing home residents had hyper tension as a primary admission or as a current diagnosis. Of these residents, 84% were receiving at least one prescription for the complication, while 51.5% of those residents diagnosed with the condition were receiving two or more antihypertensive medications. Furthermore, there have been few trials that have included NH residents and even less that have proven a significant benefit to those residents.

The improvement in efficiency and safety of drug utilization in nursing homes has been increasingly seen as an essential element of high quality care in NH’s. This care can improve function and decrease mortality in seniors. Management of the prescription, purchase, storage, distribution, and administration of medications is an important factor in improving the health and lives of NH residents.