Polypharmacy Flashcards
What makes a good team
Shared purpose
Open Communication
Recognition and Respect for one
another’s contribution
Structure or process for meeting and
carrying out roles
Trust
Organizational support
Willingness to collaborate
Atypical presentation
Vague presentation of illness Altered presentation of illness Non presentation of illness
3 types of trust
Competence trust
Contractual trust
Communication trust
Competence trust
“Trust of capability” - acknowledge skills and abilities - allow people to make decisions - involves the others and seeks input - help people learn skills
Communication trust
“Trust of disclosure” Share info Tell the truth Admit mistakes Give and receive constructive feedback Maintain confidentiality Speak with good purpose
Contractual trust
Trust of character
- manage expectations
- estabilish boundaries
- delegate appropriately
- encourage mutually serving intentions
- keep agreements
- be consistent
Core competencies for inter professional practice
KNOWLEDGE
Roles of other health professionals
SKILLS
Communicating with others and reflecting
upon
my role and others
ATTITUDES
mutual respect
willingness to collabora
What makes a team successful
- Interactional determinants(moods, attitude) -Organizational determinants (fall risk assessment team, how they’re set up, is there a hierarchy) -Systemic determinants (what does your licensing body tell you that you can do, policies and rules)
What’s polypharmacy ?
Many drugs More than 5 Indicates the use of more medications then clinically indicated or warranted - mobility - do they have more than one prescriber - renal failure - cognitive impairment - recent change in health or functional status
Factors leading to polypharmacy
Physician factors - presuming pts expect meds - prescribe without proper assessment - poor instruction - lack of med review - automatic refills - lack of knowledge Patient factor - seeing multiple physicians - hoarding - not reporting all medications - assumption that meds should be taken indefinitely - changes to daily habits
Problems with polypharm
ADRs especially with OTC Drug drug interactions Decreased medication compliance Poor quality of life Unnecessary drug expense
Body drug distribution in older adults
Decreased renal function Less water in the body ARCs Adipose tissue: lean muscle mass is altered Nurse role: Serum albumin levels Hypoalbuminia Dehydration
Beers criteria (must know)
High risk categories 1. Anticholinergics (dry mouths, urinary retention, OHTN, confusion, vision change) 2. Tricyclics (sedating, confusion, falls) 3. Antiemetics (drowsy) 4. Digoxin (heart, digoxin toxicity) 5. H2 blockers ( confusion) 6. Benzodiazepines ( just bad) 7. Narcotics
Interventions
Do not treat side effects with another medication Frequent med reviews Decrease if possible Add one at a time
age related changes and polypharmacy
Decreased body water
Decreased lean tissue
Increased body fat
Decreased serum albumin
levels
Decreased liver and
renal function
Altered homeostatic
mechanisms
Altered receptor
Negative function consequences of polypharmacy
•Increased
probability of
adverse effects
•Unpredictable
therapeutic effect
•Mental changes
and other
•functional
impairments
risk factors of polypharmacy
Pathologic processes
Functional Impairment
Inappropriate
prescribing
Polypharmacy
Inadequate
monitoring
Financial Factors
Insufficient recognition
of adverse effect
steps for drug reconciliation
- verificationby collecting an accurate list
- clarification questions about drugs, doses, frequency, and other drug pertinant information
- reconciliation of any discrepencies or concerns by communicating with prescribing practitioner
Complexity?
Older adults have a higher
vulnerability to illness…more
likely to develop chronic
illnesses
Threshold for disability lessens,
potential for increased “frailty”
