Overprescribing

[marjoriemac, LPN]

Don't you just detest GP's who constantly add more meds to a residents kardex but never actually review them? Even worse are the nurses who do not question why someone is still on a drug they have not used in 3 months (excluding of course GTN, 3 monthly injections etc). GP's are so hard to get to actually formally come to review meds. I think some just don't have the guts to say, 'hey, maybe she doesn't need that anymore'.

[nightmare, RN]

We have a sheet with all the residents names on and about two residents a week are put down on the docs list for drug review.That means they all get reviewed regularly.

[swelmorphis]

I could not agree more. This is one of my pet peeves. I work in geriatric psych, and you would not believe the amount of meds our patients are admitted on. Often multiple meds for the same condition, lots of prn's even though the MAR does not indicate that the patient has needed them for some time. This week, our psychiatrist actually wrote to discontinue two of a patients meds to "simplify" the meds! If meds can be dropped just to make things more simple, you wonder if they are necessary in the first place. Often we see patients who are delerious or otherwise impaired simply from the meds, and we often start by looking at what we can subtract before we consider adding. Another pet peeve of mine is when a psychiatric patient is stabilized and returned to the nursing facility, the MD frequently reduces the med, or insurance doesn't cover, so the med is reduced or stopped. Then, the nursing facility is calling for an evaluation because the patients behaviors have mysteriously reappeared! Also...I can't stand when a residents goes inpatient med/surge and returns to the nursing home with the med/surge meds ordered...and no one considers restarting the psych meds. Thanks for letting me "share"!:lol2:

[marjoriemac, LPN]

And you're GP's are ok with that? Your are one lucky lady!

[marjoriemac, LPN]

Same here, when residents come out of hospital they are never sent back with their night sedations or pain killers or laxatives. Yet we are told by the resident that they were getting them i hospital.

[nightmare, RN]

Some of ours have been on "short term" medication for years! I mean what good is 1mg Diazepam doing to someone who's been on it for 4 years?

I went on a course where they said sleeping pills should be rotated ever few months to get the benifit,have you ever seen that happen in practice because I haven't!

The one thing however that I hate seeing happening is when the doc discontinues a drug immediately without the usual weaning off period.Then they wonder why the resident suddenly gets so agitated or even ill!

[swelmorphis]

Marjoriemac,

We have not had much complaint from the GP's when we send the patient back "home". Often they have tried without success to manage the patient and are willing to change what is necessary. It is usually negative behaviors that brings the nursing home to call on us, often very difficult to manage.