Published Mar 23, 2014
I scratch my head every time I work the cart at a 60 bed ltc facility (Which isn't often, because I stay at home with the kiddos or I work as the wound care nurse or doing admissions/assessments). This is what boggles my mind an elderly women with sever Alzheimer disease receives 13 different medications at the 0900 medication pass, from four different vitamins to sorbitol to antiphycotics to beta blockers to pain medication and many more. Hmm what are the chances they interact, what are the chances they no longer work accordingly. From what i have been taught pretty great. This doesn't just happen with one patient but with almost all of them. I realize that quarterly the medications are reviewed by the Pharmacist, MD and RN doing the assessment so do they believe this is a-ok and I am the one overreacting. Does anyone else deal with this in LTC and is there a resourceful way to bring it up to your physician/DON??
We have the pharmacy look at the meds every month. Last quarter we got rid of 49 medications. Luckily we have a new sub-acute medical director who is NOT into over prescribing. Lots of the docs are afraid they'll get sued if they don't order every med out there.
Our pharmacy will quickly recommend restarting almost everything we d/c including multivits. Our psychiatrist does not like to stop most meds until the resident is almost end of life.She considers this "comfort care". And then you have the family members who believe every article they read in the Reader's Digest-can't blame them, they are grasping at straws.I have worked places where the med carts tipped over if you took a corner too quickly,they were so over loaded.
I've always wondered why I'm giving statins to 95-100 yo residents. And multi vitamins.
Yes.....it is mind boggling the amt of meds that are given to our elderly. I wish there was a way to d/c all meds and then reintroduce as needed.(I am not talking about pain meds antipsychotics ect) Fish oil, mult vit, vit d, calcium, and do we have any documentation that any of these are effective at 90+years of age?? It is frustrating, I want our residents to have well meaning lives and you come in with a bucket of pills and their smile fades...."oh, you again"....says it all.
Our pharmacy audits charts on long term pt qmonthly. Never seen any rec to d/c vitamins. Only reduce or taper anti anxiety, antidepressant, sleeping tabs, etc. out of my 28 long term patients, for a 3-11 med pass there are of an averaged 15 pills per person. Ex: senna s, oscal, Vit c, Vit b12, occuvite, mvi, Vit d3. One MD in particular orders vitamins like they are going out of style. Maybe I don't get the logic.... But a ltc resident at age 90 shouldn't need to be on all supplements....l:(
JBMmom, MSN, NP
I wish we could start feeding our residents *real* food, get away from processed crap that's not providing nearly the natural vitamins and nutrients they need. I wish we could get them to be more active, and get them outdoors sometimes for some fresh air and sunshine (when the polar vortex has moved on at least). So many of them are on so many medications, no one can possibly know what the cumulative effects have been on these people. So many things are related to diet, we wouldn't have to give them any bowel regimen meds, the reflux inhibitors, the statins and many hypertension meds, if we just fed them better. (But medicare won't reimburse food, just meds, so I don't think that will ever happen) It is sad, and it's one of those things I'm going to prepare for in advance of getting to the age where no one will listen to my opinion- I'm going to have some very explicit instructions when I get older on what to give me and what to keep away from me. I find it very frustrating to see.
I believe that what you are describing reflects the lack of patient advocacy in our health care world.
Who would you imagine should review these medication plans of care and recommend changes?
Pharmacists are trained to interact with pharmaceuticals. Physicians are trained to prescribe them.
Nurses are trained to advocate for the patient.
Recently my 91 year old uncle died. He was taking one medication, lasix, to prevent his ankles from swelling uncomfortably. Had his medical team had their way he would have been on statins and anticoagulants and a glut of other medications.
Regardless of his "noncompliance" he lived a hearty life, independently in his own home until he died a very peaceful death.
We over medicate the crap out of people.
Thank you all for posting your thoughts and opinions. During a monthly meeting I brought up this issue to my DON and medical director. The doctor agreed and said she had been thinking about eliminating medication due to new studies finding them not beneficial. Now at her quarterly meeting with pt she is eliminating medications that are not necessary. This is what I love about the health care field, you can see progress in the best interest of our patients!!
BuckyBadgerRN, ASN, RN
I just love the legally blind residents receiving Occuvite/I-vite. Really?
morte, LPN, LVN
depends what the cause of their blindness is, and remember, legally blind is not fully blind. This may be an attempt to maintain what they have left.
xoemmylouox, ASN, RN
I'm glad some MDs are willing to address this serious issue. I think diet is a huge problem as well. The food is unhealthy and tasteless at best.
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