MisManagement Pills - Not Management Pills

Task-specific standard operating procedures that should be present in facilities with controlled drugs. Medicines, Ethics and Practice has the most up-to-date legal requirements for record keeping of CD transactions [16]. The registers are a legal document; therefore, entries must not be cancelled, obliterated or altered. If amendments are made, the register should be clearly documented to show which staff member made the amendments, with dated marginal notes or footnotes [16].

CD registers must be kept for two years from the date of the last entry [17]. Requisitions for CDs, records of destruction and invoices must also be kept. Hospitals or facilities in secondary care who supply stock CDs to another facility that is not the same legal entity must now use the approved mandatory requisition form except in the case of hospices or prisons [16].

Improving and standardising the management of controlled drugs

Requisitions should be kept for a minimum of two years from the date on the request, while there is a recommendation to keep destruction registers for seven years and invoices for at least six years [14]. Audit of CD record keeping is essential to ensure legal requirements are being adhered to. Poor record keeping can lead to problems with fraud, diversion i. A number of changes were made to ensure best practice principles were standardised and adhered to.

Since the introduction of the new CD registers, there has been a significant improvement in CD documentation clarity and compliance with legal standards.

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The Care Quality Commission has reported an increasing number of diversion or misuse incidents of CDs by healthcare professionals [2]. Within pharmacy, a spike in requests for stock top-ups of codeine or requests for CDs by an unauthorised practitioner may raise suspicions of diversion and should be reported. Potential approaches to reducing the risk of diversion include:.

Any approach to managing diversion must be appropriately risk assessed to ensure that it does not detrimentally impact patient safety or experience, and should be undertaken by a pharmacist with appropriate seniority alongside the controlled drugs accountable officer CDAO. All organisations must have clear processes for reporting CD-related incidents. All healthcare professionals are required to raise concerns regarding diversion of CDs.

Stock control of liquid CDs is extremely difficult as loss of volume is inevitable when repeatedly manipulating a stock bottle of liquid. However, this does not consider the number of manipulations made and so looking at the loss per manipulation may be a much more accurate measurement of loss, as the more manipulations, the greater the risk of loss owing to inaccurate measurements, spillage and residue formation. Other measures can help ensure the loss per manipulation is reduced e. Regular physical balance checks enable identification of diversion; however, the number of checks should be limited because introducing too many may also contribute to losses.

See Figure 1 for an example of how to manage liquid CD discrepancies. Managing liquid controlled drug volume discrepancies — the HCA Healthcare process. Pharmacists have a responsibility to ensure the safe and secure management of CDs, both operationally and clinically. They must ensure that the necessary operational processes are regularly process mapped, risk assessed, and embedded via a sustainable programme of audit and sharing of lessons learnt, both within and outside their organisations. Simple changes, such as reviewing CD documentation or reviewing management of liquid CDs, can result in substantial improvements.

Operational standards should be adhered to and pharmacists should be aware of how CDs are managed within their area of responsibility, along with how to spot potential issues and how to report concerns regarding non-conformance or diversion via the appropriate channels. Clinically, pharmacists must take necessary steps to assure themselves that quantities prescribed are appropriate when dispensing prescriptions. Pharmacists should ensure all patients receive clear information on how to take their medication safely, including providing advice about driving and safe disposal at home.

Fourth report — the regulation of controlled drugs in the community. The safer management of controlled drugs — annual update Facilitating anticipatory prescribing in end-of-life care. Pharm J ; Glasgow and Clyde engage pharmacy palliative care facilitators. Pharmacist-led, interdisciplinary model for delivery of supportive care in the ambulatory cancer clinic setting. J Oncol Pract ;6 6: How pharmacists can help manage chronic pain in primary care. Managing medicines in care homes. Social care guideline [SC1]. Misuse of Drugs Act The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults , put together by the American Geriatric Society, is a list of medications that older adults should avoid or use with caution.

Some pose a higher risk of side effects or interactions, while others are simply less effective. If they are simply having trouble tracking their medications, a reminder system may be helpful, but the situation is more serious if your loved one is cognitively impaired. Taking medications incorrectly can be harmful or fatal. Not all providers are alike, and there are, unfortunately, some doctors who prescribe medications inappropriately, in excess, or for unapproved uses.

Knowing the potential side effects and interactions can help you stay alert to any health changes that may occur in response to a new medication or combination of medications. If you do notice health changes, contact a physician right away. This will help the provider properly diagnose the problem — and help the patient avoid unnecessary or dangerous medications.

This is particularly important for older adults who are taking multiple medications, to ensure that they know what each medication is for and how to take it properly. Keeping the number of doctors and pharmacies to a minimum is better for you and better for the providers who must coordinate care. You should also talk to your provider if you are thinking of stopping a medication.

This one might go without saying, but if you or your loved one has had a bad reaction to any medication in the past, let your doctor and pharmacist know. Have you or a loved one ever experienced a health scare related to polypharmacy or incorrect medication management? Share your experiences with our readers in the comments.

We bought a Med-Q for our Mom. She is 86 and in good health. Our problem was getting her to take her pills at the right times. Mom has been using it for 3 months and hasn;t missed a pill!. Just take the pills in the flashing box. The brand is egreen. Nursers can check all the statics of the dosage taken by the patients.

If the dosage is not taken correctly or in time, there will be an alert. Also it has an up-to-date medication list with brand name, dosages, dosage frequencies, etc. My name is Joe from http: Medication calendar with pill box. If tablet breaking is required and the patient has difficulty doing it, consult with the pharmacist about tablets that are easier to break or tablets that are the correct dosage without requiring breaking.

Assess what dose is most difficult to remember. Assess how often a dose is missed or an extra dose is taken. Teach the patient or caregiver the use of memory cues based on one of the following methods: Ask if the patient or caregiver is usually aware of the time of day or keeps track of time through a watch or clock. Daily ritual, such as using the bathroom in the morning, shaving, or hair combing. If the patient requires additional support, Provide memory-enhancing methods or devices such as Medication calendar or chart. Electronic reminder or alarm.

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Combine methods and devices when possible. Discuss dose simplification with the prescribing provider. Intentional Nonadherence Assess if medication doses are missed intentionally. ACE-inhibitors , Beta-blockers , Calcium channel blockers , If the patient intentionally misses doses, assess the reason s. Belief medication is not helping. Fear of adverse side effects. The following medications are most risky for patients to miss: If the patient misses medication doses for reasons related to health beliefs, Explore with the patient his or her health concerns for not taking medication.

Discuss the benefits of taking medication as prescribed.

The Hidden Epidemic: Medication Mismanagement

Provide positive reinforcement for taking medication as prescribed. For patients on high-risk medications, reinforce the danger of missing medication doses. If the patient misses medication doses for reasons related to medication side effects, Explore with the patient a plan to manage the side effects.

Ongoing Monitoring For all patients on a prescribed medication regimen, monitor the patient with each encounter for the following: Medication adherence Monitor both under- and overadherence. For persons using inhalers, assess Inhaler emptying rate. Use of short-acting inhaler. Medication side effects 67 , If medication side effects present, notify the prescribing provider, as appropriate. Lab work, as appropriate, for prescribed medications Cockcroft-Gault Formula or other creatinine clearance measure at least annually.

Medication effectiveness If signs and symptoms of the problem the medication is treating are present, notify the prescribing provider, as appropriate. Research Implications There is a large volume of research related to medication management and the elderly. Conclusion Medication management is a complex process that consists of multiple activities. Drug-related morbidity and mortality. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Drug-induced illness as a cause for admission to a community hospital.

J Am Geriatr Soc. Drug related hospital admissions: Factors predictive of outcome on admission to an acute geriatric ward. Depression, cognitive impairment, and understanding of medication directions in hospitalized elderly patients. Adherence to antihypertensive medications across the life span. Elderly patients' problems with medication.

The effects

An in-hospital and follow-up study. Eur J Clin Pharmacol. Self-reported memory of medication use by the elderly. Am J Health Syst Pharm. Compliance of osteoporotic patients with different treatment regimens. Isr Med Assoc J. Inconsistent use of diabetes medications, diabetes complications, and mortality in older Mexican Americans over a 7-year period: Impact of patient perceptions on compliance with treatment for hypertension. Ethnic differences in antihypertensive medication use in the elderly. Epub Dec Age as a major factor affecting adherence to medication for hypertension in a general practice population.

Drug therapy in the elderly: Br J Clin Pharmacol. PMC ] [ PubMed: Social support and compliance with hypertensive regimens among the elderly. Journal of Mental Health and Aging. Impaired cognitive function and compliance with antihypertensive drugs in elderly: Medication adherence in persons with cardiovascular disease. Social support and patient adherence to medical treatment: Lorenc L, Branthwaite A. Are older adults less compliant with prescribed medication than younger adults? Br J Clin Psychol. Major depression and medication adherence in elderly patients with coronary artery disease.

Relation of sociodemographic, clinical, and quality-of-life variables to adherence in the cardiac arrhythmia suppression trial. Noncompliance with antihypertensive medications: J Gen Intern Med. Treatment of depression improves adherence to interferon beta-1b therapy for multiple sclerosis.

How does depression influence diabetes medication adherence in older patients? Am J Geriatr Psychiatry. Predictors of older adults' capacity for medication management in a self-medication program: Depression increases diabetes symptoms by complicating patients' self-care adherence. Individuals with type 2 diabetes and depressive symptoms exhibited lower adherence with self-care. Incidence and types of preventable adverse events in elderly patients: Adverse drug events in high risk older outpatients. Variation in medication understanding among the elderly.

Medication regimen complexity and adherence among older adults. Image J Nurs Sch. Compliance with sulfonylureas in a health maintenance organization: Communication, compliance, and concordance between physicians and patients with prescribed medications. Am J Public Health. Medication adherence in elderly patients receiving home health services following hospital discharge. Is cognitive impairment a risk factor for poor compliance among Japanese elderly in the community? Factors contributing to medication noncompliance in elderly public housing tenants.

Drug Intell Clin Pharm.

Cognitive factors and the use of over-the-counter medication organizers by arthritis patients. The effects of initial drug choice and comorbidity on antihypertensive therapy compliance: Discrepancies in the use of medications: Botelho RJ, Dudrak R. Home assessment of adherence to long-term medication in the elderly. Predictors of medication noncompliance in a sample of older adults. Factors associated with low compliance with lipid-lowering drugs in hyperlipidemic patients. J Clin Pharm Ther. How often is medication taken as prescribed?

A novel assessment technique. Potentially undesirable prescribing and drug use among the elderly. A critical review of admission and discharge medications in an elderly Australian population. Perceived versus actual medication regimens among internal medicine patients.

Medical errors related to discontinuity of care from an inpatient to an outpatient setting. Bonner CJ, Carr B. Medication compliance problems in general practice: Aust J Rural Health. Fineman B, DeFelice C. A study of medication compliance. Medication use and rural seniors. Who really knows what they are taking? Drug related medical emergencies in the elderly: Do too many cooks spoil the broth? Multiple physician involvement in medical management of elderly patients and potentially inappropriate drug combinations.

Compliance with medication orders among the elderly after hospital discharge. Medication management in an elderly, community-based population: Self-reported medication non-compliance in the elderly. Self-management of over-the-counter medications by older adults. The use of over-the-counter medication by elderly medical in-patients. Neafsy PJ, Shellman J. Adverse self-medication practices of older adults with hypertension attending blood pressure clinics: Internet Journal of Advanced Nursing Practice. Inappropriate medication use in community-residing older persons.

Polypharmacy and hospitalization among older home care patients. Inappropriate prescribing for elderly outpatients. Predictors of medication use, compliance and symptoms of hypotension in a community-based sample of elderly men and women. Inappropriate medication prescribing in homebound older adults. Appropriateness of medication prescribing in ambulatory elderly patients. Possible medication errors in home healthcare patients. Straand J, Rokstad KS. Elderly patients in general practice: Inappropriate drug prescribing for the community-dwelling elderly.

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Potentially inappropriate medication use in the community-dwelling elderly: Suboptimal prescribing in elderly outpatients: Polypharmacy management in Medicare managed care: Am J Manag Care. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Naunton M, Peterson GM. Evaluation of a home-based follow-up of high risk elderly patients discharged from hospital. Journal of Pharmacy Practice and Research. Improving medication use in newly admitted home healthcare patients: The impact of clinical pharmacists' consultations on geriatric patients' compliance and medical care use: Pharmacist-led medication review in patients over A randomized, controlled trial in primary care.

Effects of an education program for community pharmacists on detecting drug-related problems in elderly patients.