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How nurses and pharmacists can manage polypharmacy in older patients

NPS MedicineWise clinical adviser Dr Philippa Binn
Photo: NPS MedicineWise clinical adviser Dr Philippa Binn
Statistics show around one in three unplanned hospital admissions for older Australians are related to issues with their medicines – and half are preventable. A new educational program targeting health professionals, particularly nurses and pharmacists, aims to reduce the rate of adverse medicine events in patients aged 75 and over, writes Karen Keast.

Research shows more than 40 per cent of Australians aged over 50 are taking five or more medicines a day while twice as many people aged 75 years and over are taking multiple medicines.

The figures reflect a growing number and complexity of comorbidities occurring with age but a reliance on more medicines is also placing the nation’s older population at greater risk of adverse medicine events.
To combat the issue, not-for-profit organisation NPS MedicineWise recently launched an educational program and publication, titled Older and Wiser: Promoting Safe Use of Medicines in Older People, aimed at equipping GPs, nurses and pharmacists with a series of strategies to manage polypharmacy and prevent medicine-related problems in patients aged over 75.

NPS MedicineWise clinical adviser Dr Philippa Binns says a large proportion of adverse medicine events in older people can be prevented through addressing prescribing and monitoring issues and by increasing awareness of the signs and symptoms associated with a medicine-related problem.

“NPS MedicineWise is encouraging all health professionals, including pharmacists and nurses, to adopt a coordinated approach to medicines management as an important aspect of a care plan for an older person, and to engage older people, their family and carers as active partners in health decisions,” she says.

“We’re encouraging health professionals to consider current medicines as the cause of new symptoms before attributing them to a medical condition - don’t assume symptoms relate to old age.”

Inappropriate prescribing is a common problem in aged care facilities.

A recent survey of 2465 Sydney nursing home residents revealed about half were prescribed psychotropic medicines including antipsychotics, hypnotics, anxiolytics and antidepressants.

Dr Binns says evidence suggests there is extensive off label use of antipsychotics for dementia patients in residential aged care.

“While they can occasionally be effective for short term aggression and psychotic symptoms – we see them being used too often, for too long at high doses and in dangerous combinations,” she says.

“Incorrect use of antipsychotics can have serious consequences including an increased risk of falls, hip fractures and even death.”

Dr Binns says an Australian study of patients living in aged care facilities showed the use of olanzapine is associated with a much greater risk of falling.

Another study of residents in low-level residential aged care in Sydney found 60 per cent were exposed to anticholinergic or sedative medicines, mostly psychotropics, and 10 per cent took three or more.

Nurses play an integral role in recognising medicine-related problems in older people, and can identify those at high risk of encountering problems with their medicines.

Consequentially, the Australian Nursing and Midwifery Federation (ANMF) has thrown its support behind the NPS MedicineWise program.

“Nurses will work with other health professionals to coordinate a care plan for older people who need to take multiple medicines on a daily basis,” ANMF federal secretary Lee Thomas says.

“We’re also encouraging older people themselves to become active partners in their medicines management by talking to their doctors, nurses, family and carers.”

Dr Binns says the program encourages nurses to develop and document a plan in partnership with their patient.

“Nurses can assist older patients implement non-pharmacological interventions, e.g. - to treat behavioural and psychological symptoms of dementia,” she says.

“They can also undertake important activities such as identifying and reporting potential adverse drug reactions and addressing difficulties older people may have with managing medicines, such as swallowing tablets or using inhalers.”

Pharmacists are also crucial in the fight against adverse-medicine events.

Dr Binns says pharmacists can recognise when medicines carry a substantially higher risk of adverse events or when medicines have no clear evidence-based indication for use in older people.

She says pharmacists can conduct a medicines review, and identify and report suspected medicine related problems like adverse drug reactions or non-adherence.

“They play a key role in supporting patients in keeping an up-to-date and accurate medicines list that includes all the medicines a person takes, including prescription, over-the-counter and alternative complementary medicines.”


NPS MedicineWise offers a range of resources -

For pharmacists:
• Medicine lists can be ordered or downloaded for free from the NPS MedicineWise website and are also available as an app for iPhone and iPad.
• NPS MedicineWise and Webstercare have collaborated to provide pharmacists with a mechanism to report on the use of antipsychotic medicines in residential aged-care facilities.
• A Pharmacy Practice Review will be available in 2014. Pharmacists can register for an e-alert.

For nurses:
• NPS MedicineWise has developed a number of Drug Use Evaluation toolkits for healthcare professionals working in residential aged care. Each toolkit provides resources and information to review current prescribing practice and provides a structured feedback to promote best practice use of medicines in aged care facilities.
• Nurses can use a Medicines Risk Screen tool to identify risk factors in their older patients.
• NPS MedicineWise will run interactive workshops for residential aged care facilities as part of the program, covering how to manage behavioural and psychological symptoms of dementia. Contact NPS MedicineWise Customer Service to find out more.

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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords