Unnecessary Drugs: Part 1: Just what is an unnecessary drug?

Tracey Pierce, RPh., CGP, FASCP, Consultant Pharmacist, ICP, Inc.

Many health care workers believe "unnecessary drugs" refers to psychotropic drugs used as chemical restraints. While this is true, the actual defi nition is much broader since the inception of the term. It includes several components:
  1. Diagnosis / reason for use
  2. Adequate drug monitoring in place (labs, assessments, side effects)
  3. No harmful side effects present or additional drugs to be added to medication regimen
  4. Acceptable dose range (neither to high or to low)
  5. No duplications of therapy (2 drugs with the same mechanism of action)
  6. Duration of therapy should be acceptable (not excessive)
  7. For residents receiving psychotropic drugs for behavioral disturbances associated with dementia, an attempt to reduce / discontinue the psychotropics, are attempted (frequency dependent on the type of medication ordered) unless clinically contraindicated.

Any medication, even Tylenol or baby aspirin can be considered an "unnecessary drug" if any of the above apply. For those of you who have been in long term care more than 20 years, you might recall the years when " gradual dose reductions" were fi rst introduced to eliminate chemical restraints. A list of medications that might be used as chemical restraints were under scrutiny, and included primarily antipsychotics and anti-anxiety agents.

The intent of the regulations regarding unnecessary drugs has not changed over the years, however the medications we are focusing on are increasing in number, the language of the regulations has been updated, and the scrutiny being used to review the use has increased. Appendix PP provides surveyors with better tools to evaluate medication use, and a more in-depth list of what to look for (thanks to the incorporation of the "Beers Criteria").

Take home message? While the current focus toward unnecessary drugs continues to be the psychotropics, all medications are potentially unnecessary. Part 2 of this 3 part series will explore examples of unnecessary drug situations (both with psychotropics and other classes of medications).


Unnecessary Drug Related Articles:

Part2: Situations in which an Unnecessary Drug Citation Could be Given.
Part3: Avoiding Citations