Effective management of medication reviews at the nursing home - What a medication story should contain

This article is written based on Swedish conditions. Hopefully, it can inspire those interested from other countries.

Older people have often had medications prescribed by different doctors at different times. In order to get a picture of what was the basis for the medication being originally prescribed, it can be good to have a medication history. When the medication history is ready, it is good if the doctor can also go through it together with the resident and relatives. In this way, additional information can emerge. At the same time, the resident gets a reminder of why they are taking the various medications.

Foto: Mostphotos

Effective Management of Medication Reviews in Elderly Care Homes

Medication reviews are a way to map out a patient's prescribed and used medications to ensure safe prescriptions. The review includes analysis, reassessment, and follow-up of the patient's entire medication use. The purpose is to find drug-related problems (DRP). It also improves the quality and safety of drug treatment, especially in frail elderly people who are a vulnerable group. There are two types of medication reviews, simple and in-depth.

Most drugs are not prescribed by the same doctor who previously initiated the medication. It is not certain that the initiations and assessments related to the initiation are available in the same medical record. Sometimes there may not be clear documentation about how the doctor was thinking when initiating the medication. This means that later doctors have to guess how their colleagues thought earlier and why.

A man in a nursing home took Haldol when he moved in. Haldol is an older neuroleptic that is not used much today. When the nurse began to investigate why the man was taking his Haldol, it turned out that he had been taking it since 1964. It had been initiated when the man was hospitalized for depression. The dose was too low to really have any antipsychotic effect. The nurse and the doctor agreed to discontinue the medication. After a while, the man's walking ability improved. He also showed fewer signs of dry mouth and generally seemed more alert.

For a patient who has had many medications initiated over a long period and by different doctors, it can sometimes be good, if not necessary, for a pharmacist to do a review of the medications and compile this in a medication story that can be attached to the medical record. It is then easier to get an overview of the medications and why they were initiated. It can also serve as a basis for starting to try to discontinue certain medications, especially in a situation where certain disease symptoms are suspected side effects.

Medication reviews are an important part of care in nursing homes to ensure that residents receive the right medication in the right doses and that any risks or side effects are minimized. Through strategic planning and careful follow-up, the nursing home can create security and safety for the residents.

What is a medication review?

A medication review is a systematic review of a person's medication therapy. This means that all the medications a person takes are carefully reviewed to assess their effectiveness, potential risks, and potential interactions between different medications. The purpose is to ensure that the medication therapy is as safe and effective as possible for the individual.

What should a medication story contain?

A medication story is a summary of a person's current medication therapy and is used as a basis for medication reviews. It should contain the following information:
- A list of all the medications the resident takes, including name, dosage, administration method, and time of intake.
- Indication for each medication, i.e., which disease or condition the medication is intended to treat.
- Any allergies or hypersensitivities to certain medications.
- Previous or current side effects or problems related to the medication therapy.
- Information about any self-medication or use of over-the-counter drugs or dietary supplements.

Working with Medication Reviews in Nursing Homes

To ensure that medication reviews are performed in an effective and safe manner, the nursing home can take the following measures:

- Appoint a responsible person who is in charge of planning medication reviews and ensuring that there are medication stories.
- Work with good methods for medication reviews, for example, Phase20.
- Collaborate in teams to get a holistic view of the resident's health status and any side effects.
- Inform and involve the residents and their relatives in the medication review process so that they feel involved and informed about their medications.
- Follow up and evaluate the effects of completed medication reviews and take necessary actions to improve medication therapy and safety for the residents.

By proactively working with medication reviews and having well-organized routines for managing medication therapy, the nursing home can ensure high quality and safety in care for the residents.

Reflection Questions - Medication Review and Medication Story
Care Staff:
- How do you handle situations where a resident does not want to take medication?
- Do you get information if someone gets new medication or stops taking something?

Manager, Nurse, Occupational Therapist, and Physiotherapist:
- Do your doctors write medication stories so that it is clear when medications were initiated and why treatment began?
- Do you keep medical records about the information you get when the doctor makes prescription changes?

Resident and Relatives:
- Have you been asked about why medication was initiated in the past?

Erland Olsson
Specialist Nurse
Better care every day

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