Despite risks, medications are often needed to maintain health and well-being. Clinicians can help ensure medication safety by keeping current on medication information, reviewing medications frequently to verify need, and educating the patient and family about safe administration practices.
Clinicians have a professional responsibility to keep informed about new medications and new research on medications and their use. Often adverse effects of medications are not known until many people use the medications over a period of time. For example, findings from the Women’s Health Initiative (WHI) in 2008 revealed that a widely used exogenous estrogen, thought to be safe and beneficial to postmenopausal women, actually increased risk of breast cancer (Heiss et al., 2008). That research changed the once automatic response to prescribe estrogen for menopausal women.
Between 2003 to 2005, the Food and Drug Administration (FDA) issued a series of black-box warnings regarding potential metabolic and cardiovascular adverse effects from atypical antipsychotic medications (Rosack, 2005, Katzung, 2012). That research changed the first line therapies once prescribed, and now clinicians must look to updated information as medications change frequently from first- to second- and third-generation drugs, with improvements in recommendations.
One maxim of geriatric care (care of older adults) is that it is often more effective to remove a medication than to add one. Be aware that herbals and supplements can interact with prescribed drugs. Most of the “herbal antidepressants” are chemically related to MAOIs (monoamine oxidase inhibitors), a drug class that can result in a hypertensive crisis if a minimum 2-week wash-out interval is not observed before starting an SSRI. A wash-out interval is the time period to allow the medication to completely be eliminated from the body and is related to the half-life of active ingredients in pharmaceuticals. The half-life varies from medication to medication.
Patients continue to believe that herbal medications are essentially safe, and they are unaware that serious problems can arise when herbals are mixed with other medications. Always inquire about supplements, herbals, and OTC medications when obtaining a medication history. Encourage patients to give this information to their pharmacists as well. Make certain every medication has a current indication and is within the expiration period.
Instruct the patient or family to keep a current record of medications. This list should be in an easily accessible place in the home or in the person’s wallet or purse. When working with an older adult who is cognitively impaired, ask the family to designate one caregiver to manage the medications. This representative should be the only person to communicate with healthcare providers about changes in medications.
Consider health literacy and language competence when teaching the patient or family. Provide legible instructions in large type. After giving medication instructions, ask the patient or family member to repeat the instructions back to you to ensure comprehension. Cultural differences may exist as to how they perceive the need for medication. Some cultures have a distrust of Western medicine and may not fully adhere to the instructions; or they may supplement with home remedies or purchased herbal remedies that could counteract or compound the prescribed pharmaceutical.
- Focus exclusively on prescription drugs.
- Make certain every medication has a current indication.
- Explain that herbals and supplements are not medications.
- Advise against taking over-the-counter drugs.
Find the medication list system for your facility and become familiar with how to record the medications and complete a medication reconciliation per your facility.