Appropriate  Medications

Using medications appropriately in hospice is more than simply making sure to follow the prescriber’s directions. Appropriate use of medications means the difference between a good and great quality of life for the patient. It also means the difference between a happy boss and a boss with a scowl on pharmacy invoice day.

Ultimately, what is best for the patient ends up being best for the hospice

The Center for Medicare and Medicaid Services (CMS) is focused on decreasing the number of drugs Medicare patients are taking. This is evident in the latest changes to the Long Term Care Conditions of Participation effective November 2017 and the requirement to discontinue “all unnecessary medications.” Multiple studies have shown the relationship between adverse drug events and the number of medications a patient takes.

Unfortunately, at the end of life–when focus should be on comfort and quality of life–the average number of prescriptions per patient increases to as many as 20 medications a day.  Studies show that when a person takes 5 or more medications daily (94% of hospice patients on admission), patients face the following risk increases:

  • 58% risk of adverse reaction
  • Up to 54% risk of cognitive impairment
  • Risk of fall and recurrent fall increases
  • 48% risk of hip fracture
  • Increased rate of urinary incontinence
  • Poorer nutritional status: decreases fiber, fat soluble & B vitamins intake and increases in cholesterol, glucose and sodium

Risks increase exponentially as medications increase when medications are discontinued systematically, using tools such as STOPP/START and PresQUIPP, patients report up to an 88% improvement in quality of life. What more can we ask for as health professionals?

 

1) McNeil, Michael J., et al. “The burden of polypharmacy in patients near the end of life.” Journal of pain and symptom management 51.2 (2016): 178-183.
2) Shah, Bhavik M., and Emily R. Hajjar. “Polypharmacy, adverse drug reactions, and geriatric syndromes.” Clinics in geriatric medicine 28.2 (2012): 173-186.
3) Lavan, Amanda Hanora, et al. “STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation.” Age and ageing 46.4 (2017): 600-607.
4) Ray, S., et al. “Prospective observational evaluation of incidences and implications of drug-drug interactions induced adverse drug reactions in critically ill patients.” Indian journal of pharmaceutical sciences 72.6 (2010): 787.
5) https://www.prescqipp.info/polypharmacy-deprescribing-webkit
By | 2018-05-10T22:20:42+00:00 May 2nd, 2018|Pharmacist Corner|0 Comments

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