Medication Management in Older Adults (eBook)

Preface 6
Contents 8
Contributors 10
Is There a Problem? The Evidence of Types and Causes of Medication Errors by Healthcare Workers 12
Is There a Problem? 12
Medication Errors in the Community 13
Medication Errors in Residential Care 16
Medication Errors and Hospital Care 17
Estimating Harm 19
Conclusion 19
References 20
Quality Use of Medicines: Policy and Practice 22
Introduction 22
Setting the Scene for QUM Policy Development 22
QUM Policy Development 24
Developing Solutions: The QUM Approach 27
Developing Integration: National Medicines Policy 29
QUM in Practice 30
Evidence-Based Information: The NPS 30
An Informed Consumer: Consumer Medicines Information (CMI) 31
An Informed Health Professional 33
Development of Medication Management Guidelines 34
Conclusion 35
References 36
The Ethics of Prescribing Medications to Older People 39
Medications and Older People 39
Medical Ethics 40
Beneficence: What Is the Evidence for Efficacy of Medications in Older People? 41
Nonmaleficence: What Is the Evidence for Harm with Medications in Older People? 44
Autonomy: Consent and Older People 46
Justice: Rationing and the Elderly 48
Conclusion 48
References 49
Common Medication Errors in the Acute Care Sector 53
Human Interaction Issues That May Lead to Errors and Strategies to Overcome 53
Environmental Interaction Issues That May Lead to Errors and Strategies to Overcome 54
Technical Interaction Issues That May Lead to Errors and Strategies to Overcome 56
Conclusion 59
References 61
Common Medication Errors in Long-Term Care Settings 63
Medication Errors and Their Impact 63
Causes of Medication Errors 65
Types of Errors 66
Errors in Prescription 66
Look Alike, Sound Alike Medications 67
Illegible Drug Orders 67
Infrequent Monitoring 67
Errors Related to the Supply of Medication 68
Errors in Administration of Medication 69
Wrong Time 70
Wrong Dose 71
Altered Dose Forms 72
Wrong Resident 73
Conclusion 74
References 74
The Impact of Medication on Nutritional Status of Older People 78
Ageing and Nutrition 78
Direct and Indirect Effects or Costs 79
Appetite 79
Absorption 79
Metabolism 80
Excretion 80
Weight 80
Drug–Food Interactions 81
Impaired Swallow Reflex 81
Enteral Feeds 81
Change of Domicile 81
Malnutrition 81
Risk Classification 82
Some Drug–Nutrient Interactions that could be Incorporated into Clinical Practice 83
Metformin and B12 Status 83
CCF and Furosemide 84
Digoxin Decreases Magnesium Levels 84
Prednisolone May Deplete Chromium Status 84
Conclusion 85
References 85
Medication Management in Older Adults: What a Systematic Review Tells Us 87
What the Literature Says 87
What Are the Types and Causes of Medication Errors? 88
Errors in Hospital 88
Prescription/Medication Ordering Errors 89
Dispensing Errors 89
Errors in Administration of Medicines 89
Errors in the Medication Record 89
Errors in the Community Setting 90
General Practice 90
Pharmacies 90
Other Factors That Contribute to Medication Errors 91
Inadequate Continuity of Care 91
Multiple Health Care Providers 92
Keeping Unnecessary Medications 92
Generic Names/Trade Names 92
Understanding the Label 92
What Interventions are Effective at Reducing Medication Errors in Older Persons? 93
Effectiveness 93
Computerised Systems 94
Individual Patient Medication Supply 96
Education and Training 96
Pharmacists 96
Nursing Care Models 97
Conclusion 98
References 99
Misuse of Formulations in the Aged Care Setting 102
Medicines and Older People 102
Problems of Swallowing and Dose Form Modification 103
Dose Form Modification and the Risks for Older People 104
Altering the Route of Administration for Medicines 106
Dose Form Crushing 106
Administering Capsule Contents 107
Modifying Transdermal Drug Delivery Systems 107
Splitting Tablets 108
Dose Form Modification: Some Guidelines 108
Conclusion 110
References 110
Electronic Health Records, Medications, and Long-Term Care 112
What is EHR? 112
How Can an EHR Affect Medication Management? 112
Patient/Caregiver Involvement Through EHR Can Improve Care 114
EHR Still May Have Some Drawbacks for Medication Management 114
Conclusion 115
References 116
Computerized Order Entry 117
Potential to Reduce Medication Errors 117
What is COE? 117
Advantages of COE 118
Potential Pitfalls with COE 119
Drug-to-Drug Interactions and Information Overload 119
Selecting the Right COE 120
Administrative Features 121
Security and Standards 121
Training and Portability 121
Conclusion 122
References 123
Inappropriate Prescribing: Beers Criteria, Polypharmacy, and Drug Burden 124
Beers Criteria 124
Method of Evaluation 124
Selection of Panelists 125
Medication Selection 126
Reasoning for Categorization 126
Polypharmacy and Drug Burden 129
Conclusion 130
References 130
Dosing Errors: Age-Related Changes in Pharmacokinetics 131
Pharmacological Basis of Pharmacotherapy 131
The Right Dose for the Right Older Person 133
Absorption and Older People 133
Distribution 134
Drug Metabolism in Older Age 135
Elimination 136
Frailty and Pharmacokinetics 137
Start Low, Go Slow 137
Conclusion 138
References 138
Index 140