Nursing Role In Reducing Unnecessary Medications

As seen in the Consultant Connection January / February 2013 Issue
Kathleen Klepcyk RN

 
A resident’s drug regimen must be free from unnecessary drugs. That’s what the regulations say, F329 to be more specific. Nurses don’t need regulations to tell us this! A nurse in the profession taking care of people uses every opportunity, every contact with the resident, and every interaction with care givers to ascertain information in determining the correct drug regimen is being provided.
A nurse’s responsibility is a comprehensive clinical assessment--on admission, re-admission, or significant change, including the physical, mental & psychosocial condition. It is through these reported and documented assessments the resident receives only clinically indicated medications.
Understanding medication indications and uses: along with the aforementioned clinical assessments, ongoing monitoring, team meetings and clinical discussions, the nurse is able to identify the medication actions, side effects, allergies, effectiveness, and resident response. The nurse must be aware of other potential safety risk/hazards, or other adverse consequences, with appropriate follow-up.
These assessments will assist in identifying behaviors or reactions signifying medications that may have excessive dose, excessive duration, inadequate monitoring, inadequate indications for use, and possibly, an indication to reduce or discontinue medication.
Passing medications is not just a task. It is huge opportunity to assess the resident. While doing the med pass, a brief assessment such as vital signs, noting resident awareness, behavior, skin condition, physical functioning, and symptoms related to diagnoses can be observed and documented.
The nurse also greets the resident, asking how they are—any concerns, pain, medication effectiveness, tolerance or side effects. Meal consumption, hydration and bowel regimen can also be assessed throughout the day.
The nurse also reviews & assesses the drug regimen, lab values, relative to the medications and condition. He/she assesses nursing interventions, implementation, and care being provided.
Communicate with the resident, family members, direct caregivers, members of the interdisciplinary team (pharmacy, dietary, social services, therapy, activities, etc.) to provide further input on what has been happening, to ensure the success of the medication regimen. Look at the lab values-know what relates to which medication or condition Re-assess the resident.
For example, a male resident is receiving routine Coumadin for a diagnosis of atrial fibrillation. While performing routine AM care, the resident complains that there is a moderate amount of blood present after brushing his teeth. What is the nurse’s responsibility? Do a comprehensive assessment: vital signs, O2 saturation, difficulty breathing, bruising, pale skin, edema, dizziness, hematuria, tarry stools, hemoptysis, abd. cramping, bleeding with shaving, nosebleed, rash. etc., and check with direct caregivers, and members of the team. What is the last Coumadin dose? What is the date and results of the last PT/INR?
The pharmacist can assist with the specifics of the medications, if needed, evaluating the drug regimen and/or any reductions or changes that may be needed.
The physician should be notified as soon as possible, of the assessment findings, for any pertinent new orders and adjustment of the medication regimen.
Identification for any further assessments should occur for any other clinically significant change in condition-- a new, persistent, or recurrent symptom or problem, worsening of existing problem, or unexplained decline in function or cognition. Review med orders—new, renewed, irregularity in current orders.
In summary, remember that performing an individual, accurate assessment accompanied by communication with the team will enhance resident outcomes and keep in compliance with the regulations, specifically, F329.

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