I'm an ADON of a 45bed skilled care unit in a 100 bed SNF and was wondering if anyone has had any luck with implementing polypharmacy reduction at their facility? Spoke with our medical director yesterday about his perspective and got the usual MD procrastination response... what was I thinking? Have looked to see if any programs have been implemented, but not having any luck. Anyone have any suggestions? Don't want to go "Rambo" on my docs, but am about there with these patients being on so many meds. Thanks in advance.
Dec 31, '13
Can you utilize the help of your pharmacy consultant for any info/programs? You would then have some ammo to back you up.
Jan 1, '14
Ironically, a new Rph consultant was there yesterday and I did just that. She is in 100% agreement and will help me. Between her knowledge base and my ability to nag, think we should be able to get a grip on this.I told her about this article I read about the precsription cascade that occurs and she was very familiar with the process. So feeling very encouraged.
Jan 2, '14
There is plenty of evidence that shows more meds are NOT better. Start slowly....try getting rid of the unused PRNs. Then maybe the vitamins...it can be done but it's not easy.We've started ordering some meds for only 3 or 4 days so we don't have a lot ofextra things on the MAR.
Jan 15, '14
I presume you are computerized, which will make it easier to check for meds; start with unused prn's, if not used in 30 days, they should be dc'd. Check any neb tx that are continued after an acute episode has resolved ( pneumonia/URI), check Blood sugars for results, and if within range, decrease to BID, then QD ect..have you done reductions with psych and sleep meds? In my state we are required to reduce them quarterly and document behaviors, if none observed they can be slowly decreased over time. After that, you will have to work together with individual patients to see what is appropriate and discuss with MD. Over time, this can be done well with the cooperation of you MD and Pharmacy recommendations, it does take some time! Don't forget, per CMS guidelines, antidepressants/ anti-anxiety meds do not need to be reduced! Hope this helps!
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