Polypharmacy — the use by patients of multiple medications prescribed by multiple healthcare providers often unaware of each other — is trending. Google searches for polypharmacy over the past year are up by 35%. The majority of searches were focused on problems associated with taking multiple medications. It happens due to the lack of communication and coordination between physicians, nurses and pharmacists, and it is most common in the 50+ community.
This aging population has an increased number of treatment options and physicians to address their healthcare needs. The Lown Institute reports that more than 40% of older Americans regularly take five or more prescription drugs, and nearly 20% take more than 10 medications.
Serious risks of polypharmacy include cognitive impairment, harmful drug interactions and medications that possibly could exacerbate other medical conditions. This can further impair medication adherence, reduce quality of life and increase fall risk. Polypharmacy is an independent risk factor for Adverse Drug Events such as hip fractures and can lead to multiple preventable visits to hospitals or clinics, prolonged hospital stays and long-term placement, adding to healthcare costs; negative outcomes are not limited to deaths.
Pharmacists not only have a responsibility to properly dispense medication, but they also have a responsibility to overall patient safety. While working to meet the medication needs of residents and patients living in long-term care environments such as assisted living communities, skilled nursing facilities, correctional facilities and hospice, long-term care pharmacists are working with complex patient populations that often require multiple medication regimens.
When it comes to filling, dispensing and administering medication, mistakes by pharmacists and clinicians in long-term care facilities can happen due to poor working environments, poor communication, professional burnout, staffing deficiencies and a lack of institutional, industry, clinical or patient knowledge. From assisted living communities to correctional facilities and a number of other care settings, accuracy and safety are paramount when dispensing medications properly — which is why staff members always should follow an established safety protocol.
In addition to safety protocols, other ways exist to prevent polypharmacy. Electronic health records are helping to connect different providers together within the same health system. In nursing home settings, medication regimen reviews are federally mandated, which require a consultant pharmacist to review the medications of all residents in the facility. There are many clinicians who prescribe to patients in these settings, such as the attending physician, nurse practitioners, psychiatrists and endocrinologists. When performing MRRs, consultant pharmacists can reduce polypharmacy by identifying drug-drug interactions, duplicate therapies and unnecessary medications. Other helpful tools to prevent polypharmacy are Desprescribing.org, Medication Appropriateness Index, Beers Criteria and STOPP and START criteria.
Identifying polypharmacy and optimizing medication regimens are critical elements in the comprehensive care of older adults. They help reduce preventable ADEs such as falls, drug-drug interactions, impaired cognition, hip fractures, hospitalization rates and overall healthcare costs. It also can improve overall health status, quality of life and satisfaction of the older adult and caregiver. This must be balanced, however, against the potential benefits of medical therapies used to treat multiple disease states. Considering the increasing elderly population and its complex chronic diseases, healthcare practitioners need to be ever vigilant and tactful in managing the many medications used to treat them.
Chuck Benain is the CEO of UnitedRx, one of the largest full-service, independent long-term care pharmacies headquartered in Illinois. Developed in 2008, UnitedRx has a presence that has grown to more than 350 facilities, consisting of assisted living communities, skilled nursing facilities, intermediate care facilities (ICF-DD), hospice care and youth homes. UnitedRx serves more than 36,000 beds across 20 states, with pharmacy locations in Illinois, Pennsylvania, Kansas, Nevada and Tennessee. The company employs more than 350 people, with an average of seven years of experience in the pharmaceutical industry. For more information, visit https://www.unitedrx.net.
The opinions expressed in each McKnight’s Senior Living marketplace column are those of the author and are not necessarily those of McKnight’s Senior Living.
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