Pulling/tapering resident's meds.

JB2007, ASN, RN · Jul 29, 2009

I know that at the facility that I work for that state does not like the residents being on certain medications. The facility has to have very good documentation and prove that every other intervention has been tried before the resident goes on these meds. What meds the state does not like depends on what state you live in.

There is a potential for abuse with certain meds and they can be considered chemical restraints under certain cases. Not all nurses use the medications the way that they are intended to be used, so to save themselves trouble with state a lot of facilities will try to get those meds d/c'd when a resident enters the facility. However, they should not do it at the expense of a resident's physical or mental health.

Are you sure that your resident did not have some other condition that could have caused her rapid decline? I would think that there was a reason that this 96 year old woman entered the facility to begin with and that maybe the reason that she so rapidly declined. I know that sometimes it seems like we are doing things that are speeding up the resident's decline, but really they are old and sick and they have multiple health conditions that are going to cause their death sooner rather than later.

As LTC nurses we have to do the best with what tools we are given to make these resident's final days as good as we possibly can make them. I know that at times that it seems that we are doing things that are completly pointless and is causing more harm than good, but I have to tell myself everyday that there is a solid reason behind the sometimes ridiculous rules that are placed on us

EverNurseRN · Jul 29, 2009

we are constantly doing gdrs (gradual dose reductions) on our residents at my ltc facility...we put the resident on follow-up to make sure we have plenty of documentation ready so when we have to bump their doses back up to where they started we have proof that it was warranted. the pharmacy we use even sends us gdr recommendations every few months or six months or whatever the guidelines are for a certain med..it's annoying and sometimes those reductions hit the residents like a tornado and they go a-wall..i hate it when that happens.

RuRnurse? · Jul 29, 2009

I'm sure this poor woman had other issues, like I said, the Xanax pull alone didn't do it, but my God, WHY do this to someone of that age at all? It had to be hard enough for her to make the adjustment to placement without having her meds yanked on top of it. All I can think is that in her last month or so of life, she had to go through this...

I know that the state does make this request, but I also know that the docs can decline to do it for medical reasons, and at her age, the request should have been declined as being not in her best interests.

JB2007, ASN, RN · Jul 29, 2009

I'm sure this poor woman had other issues, like I said, the Xanax pull alone didn't do it, but my God, WHY do this to someone of that age at all? It had to be hard enough for her to make the adjustment to placement without having her meds yanked on top of it. All I can think is that in her last month or so of life, she had to go through this...
I know that the state does make this request, but I also know that the docs can decline to do it for medical reasons, and at her age, the request should have been declined as being not in her best interests.

I find this frustrating at times also, but we must do as the state says or we do not get paid. However, many of our elderly are on too many meds. I have multiple residents on my 30+ hall that are on 20+ meds and that is just the scheduled meds. There is nothing that I can do to decrease the meds even though my residents do not like taking all of these meds because the doctors and the families insist that they need all of these meds. The whole medication situation is sad really and I do not see any changes in the near future.

morte, LPN, LVN · Jul 29, 2009

I can see wanting to decrease someone's meds IF the situation warrants it. But the practice of doing this just for the sake of doing it drives me crazy! Why do this to someone if you don't have to?
In LTC, we have very elderly folks, some of whom have been stable on their little meds for years, and are doing well. So, what do some do? Why, pull them or taper them to nothing, of course! Then when they 'go off', they look for any other cause BUT the one that is most obvious. We recently had a 96 year old woman who had been on Xanax 3 times a day for several years at home, her family has said that it was the only thing that worked, and it worked quite well for her. So, what did the NCM and the docs do as soon as she got there? They tapered, then yanked the rug out from under her. At 96 years old!
So, 'granny' goes off big time, starts assaulting staff and other residents, ends up on one-to-one, then gets sick a few weeks later, goes to the hospital, and dies. Did she die because of the Xanax pull? Not directly, but then I am reminded of the line from "orificenic and Old Lace"..."He wouldn't have died if I hadn't have shot him".
God, leave these people ALONE already!

i wonder if the family could sue? they clearly stated that she had been successfully treated and apparently tried other things (the only thing that worked)...and it isnt nec a decline in "granny" that caused her admission, it could have been in her caregiver. I talked to a NP about this once....and she said no you dont have to do these tapers, but you need good documentation.....