Concerns in Medication Safety in Regards to the Older Adult

Population

Stephanie A. Ball, Taylor W. Brickley, Macey F. Davenport, Kelly L. Erexson, Emily K. Falcon, Cierra N.

Witten

IntroductionMedication safety is becoming an increasing problem

with the growth of the geriatric population.

Medication errors may occur at a greater rate in this population.

The changes in older adulthood, the collaborative healthcare team, the use of informatics, and the personal knowledge of the healthcare providers play an important role.

Medication Safety can be maintained through the nurse’s role, education, maintaining legal and ethical guidelines, as well as using evidence based practice.

Key Ideas

The use or a collaborative care team is instrumental to medication safety in the older adult population.

Knowledge of the natural aging process has been proven to be effective in reducing medication administration errors.

Informatics should be used to prevent errors.

The collaborative care team must have extensive pharmacological knowledge.

Collaborative Care

Collaborative Care

Collaborative care is the combining of many

disciplines within the healthcare institution to

provide the best care possible

Without clear communication

medication errors can occur and it is up to every member of the

team to check and double check for

medication safety in regard to the older

adult.

Medication safety is dependent on this multidisciplinary approach with an

emphasis on communication (Choo,

et al. 2010).

AORN suggests that in order to prevent

medication administration errors

the nurse must re-read the original orders

before administering the drug and there

must be clear communication between

healthcare professionals

(Webinar).

Knowledge of the Aging Process

Knowledge of the natural aging process has been proven to be effective in reducing medication administration errors in older adults.

Some of these risk factors include cognitive problems, diseases processes, socioeconomic status, living independently, and the use of multiple medications (Fialova & Onder, 2009, p. 641).

The susceptibility of the older adult to chronic disease also can negatively influence medication administration in many ways.

Cognitive problems and diseases processes can impair the ability to remember to take medications or to take them as prescribed.

Informatics

Broad term for electronic systems

Medical researchers are emphasizing the use of up-to-date-informatics systems being used for the elderly population (Fialovia, 2009 p. 642).

Informatics is not only knowing how to use the IT

systems, but also how these system effect care to the patient and avert

medication administration errors (Finkelman &

Kenner, 2013).

Systems allow doctors to see if a medication that

they would like to prescribe could cause

Polypharmacy (Fialova, 2009, p. 642).

Informatics

Pharmacology KnowledgeThe healthcare team must not only have an excellent understanding of the physiological changes of the older adult, but also pharmacological knowledge and knowledge of the potential issues that may arise from providing the medication (Tweddle, 2009 p. 938).This involves knowledge of the actions, interactions, potential adverse reactions (including side effects and allergic reactions), usual dose, route and approved use, basic pharmacokinetics of the drug and the patient’s response to it (Choo et al. 2010, p. 857).Taking too many medications at a time can have not only drug-on-drug reactions, but also that in the older population this many drugs causes an enormous safety risk.

Nurses’ Role

The nurse plays the pivotal role in collaborative care

where they can voice problems to other members of the team or even question physician orders (Choo et al. 2010, p. 859). Not only is the

nurse responsible for administering medications,

but he or she also must clearly communicate their

actions to all members of the healthcare team.

Collaborative Care

The use of informatics is one of the core competencies of

the Institute of Medicine. Due to the fact that the nurse is

the front line for medical administration it is important for nurses to be involved in

both the design and implementation of any new informatics system (Choo et

al. 2010, p. 858).

Informatics

EducationThe IOM has stressed the application of quality improvement.

There must be an increase in safety education for healthcare professionals in order to help prevent errors (Finkelman & Kenner, 2013, p. 367).

Polypharmacy

When older adults have several treatments at the same time it can lead to medication errors, such as a higher chance of adverse drug interactions (Fialova & Onder, 2009, p. 641).

Method

Having an organizational method for all their medications can be one of several effective methods of medication safety practices.

Legal & Ethical Issues

Legal & Ethical Issues

As people are living longer lives a significant group of older adults are not able to understand the reasons they need to take medications or who lack decision-making capacity.

The healthcare team must provide patient-centered care that allows the patient to make decisions about their own care (Finkleman & Kenner, 2013 p. 266).

Applying the decisions of the patient is key to providing patient-centered care, which is one of the IOM’s core competencies.

If it has been determined that a patient is unable to make decisions regarding medication, it is essential that measures be taken to ensure that medical issues are still taken care of when necessary.

Evidence Based PracticeEvidence based practice combines research and its results to help create safe and effective patient care.

One of the IOM’s focuses is on the implementation of evidence-based practice.

The use of evidence based practice methods help to ensure that medications are being safely administered to our elderly population.

In order to provide safe delivery of medications, the nurse must have the knowledge about the many changes that occur with aging, the medications the individual is taking, and how to educate the healthcare professionals on the effects these factors have on medication administration in the elderly population. Evidence based practice provides healthcare providers with this knowledge and allows them to implement systems to reduce errors and maintain safety.

Evidence Based Practice

• The nurse must ask questions about what medications the patient is currently taking and about any other “medications” that the individual may be consuming, such as alcohol. The more the nurse knows about the medications and its effects, the more they can prevent any interactions with medications that may be prescribed while in the nurse’s care.

Medication review

• One of the researched programs includes a Senior Care Specialist, which is a program dedicated to improve the knowledge and skill competencies of staff when caring for the older adult (Hall, 2008, p. 433).

Programs

• interdisciplinary team conferences discuss each patient’s goals, discharge planning, and nutritional and pharmaceutical needs (Hall, 2008, p. 433). Each discipline provided a brief summary of the patient’s progress toward the goals that were set for the patient.

Interdisciplinary team

conferences

ConclusionThe knowledge of the collaborative

healthcare team, informatics, and the older adult themselves all function together to help avoid medication errors and promote medication safety.

There is not a single method that has been proven to work for this population.

Research did provide varied ways to help prevent medication errors in the geriatric population, and some key identifiers for those older adults who may need some assistance with their medications.

References Association of periOpritive Registered Nurses. (2014). Medication Safety

[Webinar].  In Periop 101 Individual Modules. Retrieved from http://www.aorn.org/Secondary.aspx?id=26250&terms=medication%20safety

Choo J., Hutchinson A. & Bucknall T (2010). Nurses’ role in medication safety. Journal of Nursing Management 18, 853-861. doi:10.111/j.1365-2834.2010.01164.x

Fialová, D. & Onder, G. (2009). Medication errors in elderly people: contributing factors and future perspectives. British Journal of Clinical Pharmacology 67(6), 641–645. doi:10.1111/j.1365-2125.2009.03419.x

Finkelman, A. & Kenner, C. (2013). Professional Nursing Cncepts: Competenies for Quality Leadership. Burlington, MA: Jones & Bartlett Learning.

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Tweddle, F. (2009). Covert medication on older adults who lack decision-making capacity. British Journal of Nursing 18(15), 936-939.

Wang C., Fetzer S., Yang Y., Wang J. (2013). The Impacts of using community health volunteers to coach medication safety behaviors among rural elders with chronic illnesses. Geriatric Nursing 34,138-145. doi:10.1016/j.gerinurse.2012.12.013

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