Typically, polypharmacy refers to the prescription of 5 or more medications. However, it should be noted that those taking 1, 2, 3, or 4 medications also face risks. For older adults, taking a host of medications is common place. Hence, in the geriatric population, there is a great risk for functional decline and adverse events secondary to the collective host of medications that are prescribed.
In addition, quantitative studies suggest that there is, in fact, a liner relationship between the number of drugs prescribed to a patient and the number of adverse events that the patient is likely to incur (Wang KA, 2013). With these data being outlined, nurses play a pivotal role in safe medication management. And, as care providers, nurses have an obligation to work with other members of the care team to understand the patient’s complete medication profile and to make medication management easier and safer.
Furthermore, consider the make-up of the geriatric patient. In most cases, there is decreased kidney and liver function. Hence there is hindered metabolism. This, along with the complex medication regiment prescribed, makes this group especially at risk.
Because the “risk” and the “propensities” are there, consider the following strategies that providers and practitioners can take to make medication management safer:
1. Communication: Typically, when there are many co-morbidities, there are many prescribers, and communication between prescribers about the regimen is important. Similarly, nurses are generally responsible for completing the medication reconciliation. This is a crucial practice, and ascertaining that the prescribed dose and name are accurately documented is the first step in making “poly-pharmacy” safer.
– The Patient: It is important that the patient report the dose that he or she takes, and this takes a collaborative partnership between the nurse and the patient. For instance, in some cases, the dose might be 10 mg, but the patient might take 5 mg to reduce expense, and the clinical presentation might actually suggest that the 5 mg dose is effective.
– Education: In many cases, patients are not aware of the indication for a prescribed medication, and they might not be aware of the side effects of abruptly discontinuing the medication. Nurses are educators, and they have a role in helping with the preparation of “pill-boxes” or teaching the patient and the family about the indication for the medication.
2. Medication Reconciliation: This ties in with the “communication” piece, but succinctly and accurately reconciling the medication regimen does demand communication, but it also demands precision and attention on behalf of the nurse.
3. Risk Identification: It is almost a given that older persons are at risk for inappropriate prescription medications. Nurses are especially aware of the Beers criteria -this is a list of medications to avoid in those 65 and over (Wang KA, 2013). These medications include hypoglycemics, steroids, NSAIDS, anticholinergics, and opioids. So, if one is of a certain age that is greater than 65 years-that is a risk factor. That is then accentuated with being prescribe a drug on the “Beer’s List”. So, those two risk factors are compounded.
4. Patient/Support System Education: The importance of patient and/or support system education has already been referenced, but it is especially helpful if a member of the patient’s support system reviews the medication regimen with the patient and helps with medication preparation. In this case, “two heads can be/are better than one”.