Beers Criteria Question

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I have a question for you seasoned Beers Criteria knowledgeable nurses out there... Tofranil-pm Should this be given to a 78yo women...she has a hx of Breast CA(in the 80's, radical L mastectomy), severe osteoporosis, uses a walker/cane, very obstinant about asking for help with ADLs. She has taken it for a week now for problems with sleep and had a fall this am. As far as I can see elavil is on the list but not tofranil-pm, and I know Tyl-PM is also a bad one to give elderly.

SO, can anyone out there let me know about this med with the elderly.

Thank you so much for your time!

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How about asking the pharmacist for help with this one. Or even calling the doc with your concerns?

Lots of our docs still have a hard time with that list. They still love Darvocet:uhoh3:

I'm not totally familiar with the med, but maybe there are better options for her.

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Specializes in Gerontology, Med surg, Home Health.

Tofranil is an antidepressant so what is the point of giving it with PM which I assume is Benadryl? Anything with Benadryl is bad. I had a 98 year old woman on Tofranil, Ambien, Risperdal and Remeron and the doc said those were the meds she needed and that was that. He refused to change anythng. Luckily this was in homecare and the regs about meds aren't quite a stringent as in LTC.

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Specializes in med-surg, home health, hospice, LTC.

The pm just stands for the formation, not Benadryl, so its not the same as Tylenol PM as far as sedation etc. You should document what nonpharmacological interventions you have tried on this rsd, and any other meds that were tried and not effective, in order to justify the use of it as a sleep aid. (probably not appropriate according to the Beer's list) It is a tricyclic antidepressant, so be sure you are following the TCAs specific revised guidelines. You will need the physician to doc on a risk/benefit form why he is using it as opposed to a med more appropriate for sleep. Good luck, we just had our survey and got a deficiency because our nurses didn't doc that a rsd had insomnia or that we tried anything else first, (doctor ordered ativan) although the order came from a doc who isn't familiar with the new guidelines,( I don't think he'd even heard of the Beer's list), and the rsd's wife asked the doctor for it specifically, although she didn't bother to talk to nursing about it first! So of course we had not documented it, we didn't think he had insomnia, but once the order was given, we had to do what the wife wanted!:angryfire

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