Polypharmacy

Nurses General Nursing

Published

Hi all! I'm pretty new to this, so please excuse me! I am currently an LPN...I graduate in December and take my boards for my RN in January!

I work in an Assisted Living Facility and feel like a total pill pusher. I am sure that a lot feel that way, but I don't know what it is...it may be that I am a new nurse and want to make a difference, but our residents take waaaay too many medications. I have a few residents that are on 15+ meds daily. Does that sound ridiculous to anyone else or just me?

I will be leaving my employer in December, because they don't hire RN's and I want to try to make a positive impact on my resident's health prior to my departure.

Ok, so my questions are...

1. We do not have a medical director, all of our residents go to a PCP for health issues. We currently have approximately 30 different PCP's that we work with. How do you go about asking to have certain meds D/C'd? I have res. that are on a MVI, but then also take Vit. E, Vit. C, Vit. B12. That is daily. Then I have some that are on a MVI plus Folic Acid and Iron. I was taught in school that your body only uses what it needs from Vit. and Minerals and the rest is flushed from the system...was I taught wrong?

2. It seems that PCP's are ordering adjunct meds without really looking at the problem. I have a res. that takes Lyrica BID, Kadian BID, and Klonipin BID. That doesn't include her Reglan, Prevacid, Advair, Spiriva, Synthroid, and the list goes on. I wish I had a MAR here now, cause I am sure a lot of you would have to pick a jaw up off the floor after seeing them! How do you present to the PCP that there might need to be an adjustment in meds or a DC in meds that have been taken for 20 plus years and may not even be effective anymore?

3. Does anyone out there have drug holidays? If so, could I get some information on that? I really truly believe that some of my residents are on so many meds that they are in the body, fighting against each other and not producing a desired outcome as prescribed.

Ok, I'm sorry if I have bored some or brought up issues that have been an issue for years, I am just sick and tired of PCP's just RXing meds to do it. It seems like they have gotten to be like PEZ dispensers and rather than treat the problem, they are writing scripts to shut people up!

I look forward to any and all advice out there! Thanks in advance!

I've only been a nurse for 1 1/2 years, so I am new to this!

Megan

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Specializes in Utilization Management.

I don't have any advice, but I did have a patient a few weeks ago who was on 32 daily meds and she told me her cardiologist had just prescribed 4 more that she had forgotten to add to her med list! We use electronic medical record and as I was entering her meds, interaction after interaction kept popping up. I wonder if some physicians even consider potential interactions before prescribing new stuff :confused:

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Specializes in Anesthesia.

When I worked in LTC years ago we had a pharmacist come in at least once a month and review all the patient's med orders and make recommendations. Does your facility do this?

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Specializes in ICU/ER.

God Love her I had a patient last week that was 102 and only had 1 home med. yep you read that right her only pill was 1 Multi Vitamin a day...crushed and in applesauce as she had trouble swallowing it....

She was a hit at the hospital and some nursing staff just didnt belive it, they would come over and look at her Mars. Centrum was all she had listed.

At 92 she has a stroke so she started taking art classes so she could improve the cordination in her left hand. That is who brought her to the hosp, her art teacher.

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When I worked in LTC years ago we had a pharmacist come in at least once a month and review all the patient's med orders and make recommendations. Does your facility do this?

That sounds like a wonderful idea, if your facillity has one central pharmacist possibly requesting them to look at the MAR?

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Thanks for all the help! Yes, we do have a pharmacist that comes in and makes recommendations. I am in search of that listing...I work 11-7 and am the only nurse in the building...so I can look and look! If I don't find the list tonight, I am going to leave a note for my DON to see if I can get it to send faxes to the PCP's! I never thought of that before! Again, thanks for all the help!

Megan

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