Polypharmacy is an area of concern for many patients, especially the elderly. Elderly patients are at a greater risk for adverse drug reactions (ADRs) because of the reduced drug clearance associated with aging and because of metabolic changes (Boris, Cafiero & Smith, 2014). Some risk factors associated with polypharmacy are potential of drug-drug interactions because it is further increased by use of multiple drugs. Another risk factor is hip fractures, associated with adverse drug reactions and losing balance or fainting (Boris, Cafiero & Smith, 2014). Polypharmacy may sometimes lead to “prescribing cascades.”4 Prescribing cascade is said when signs and symptoms (multiple and nonspecific) of an ADR is misinterpreted as a disease and a new treatment/drug therapy is further added to the earlier prescribed treatment to treat the condition (Piere & Farrell, 2012).
In my practice working with the elderly population, to reduce the incidence of polypharmacy medication, patients are evaluated on a monthly basis. Additionally, a single drug is be prescribed instead of multiple drugs for the treatment of a single condition, if possible. Another strategy we use is staring medication with the lower drug dosage and slowly increasing as indicated.
A strategy that seems to be effective, according to research, is prescribe drugs that can be given once or twice a day instead of prescribing drugs that require to be taken three times a day (Thomas, Liao, & McCliar, 2016). The reasoning behind this is to lower the risk of forgetting to take the medication or taking the medication together with other drugs. Another strategy that can be employed is that if the drug taken has no therapeutic beneficial effect or clinical indication it should be eliminated. Unessential drugs should be identified and eliminated prescribed by different health care providers for the same condition/disease (Thomas, Liao, & McCliar, 2016).
Polypharmacy refers to the effects of taking multiple medications concurrently to manage coexisting health problems, such as diabetes and hypertension (Piere & Farrell, 2014). Too often, polypharmacy becomes problematic, such as when patients are prescribed too many medications by multiple healthcare providers working independently of each other. Also, drug interactions can occur if no single healthcare provider knows the patient’s complete medication picture. Nurses have a unique opportunity to help identify patients at risk for inappropriate polypharmacy and to educate patients and families about risk reduction. Nurses can use strategies such as patient teaching and consistency in care plan (Piere & Farrell, 2014).
Some of the risk factors of polypharmacy are age and chronic conditions. The elderly are more sensitive to the effects of certain drugs, particularly those that affect the central nervous system. As a consequence, drug classes such as benzodiazepines should be used with caution, and if absolutely necessary, then at a reduced dose to minimize the risk of falls and other adverse events (Thomas, Liao & McCliar, 2016). In addition, age is associated with decreased regulatory functions, therefore anti-hypertensives can more easily result in postural hypotension and opiates in respiratory depression. Communication barriers often go undetected in health care settings and can have serious effects on the health and safety of patients. Limited literacy skills are one of the strongest predictors of poor health outcomes for patients (Thomas, Liao, & McCliar, 2016). If the patient is deaf, can’t see or is illiterate there are various strategies the nurse can use for example, advise the patient to bring someone with them to the visit. Nurses who are responsible for checking patients in should be friendly and helpful. The length and number of forms patients are asked to fill out should be limited.
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