Myth Busting: The Medication Issue

By Mary-Lou van der Horst, Best Practice Coordinator, Long-Term Care, Central South Village of Wentworth Heights, Hamilton, Ontario. Reprinted with permission from the BP Blogger, October 2007.

June 2008- Medication side effects, adverse events and their related problems can have significant medical and safety outcomes for older adults. Studies have shown that up to 30 per cent of hospital admissions for older adults may be linked to adverse drug reactions/events. In long-term care homes over a four-year period, up to two-thirds of residents had adverse drug reactions/events and one in seven of these resulted in hospitalization.

Research on inappropriate medication use in older adults since the early 1990s has resulted in the development of the Beers Criteria for Potentially Inappropriate Medication Use List. Most recently revised in 2003, the Beers Criteria provides a list of 48 individual medications or classes of medications to avoid in older adults. It also provides a list of 20 diseases and/or conditions and medications to be avoided in older adults with these conditions. Several medication guidelines recommend that medications found to be in conflict with the Beer's Criteria list or are being used without compelling evidence should be discontinued. The Beer's Criteria list can be used when planning medication initiation, reviewing established medication regimes, or when making changes.

It's important to remember that not every resident who takes these medications will experience an adverse reaction. Staff need to be alert and monitor for the possibility that adverse reactions may occur so that appropriate steps may be taken before they occur.

The goal of doing this is to:

• eliminate unnecessary medication;
• improve medication management; and
• promote the highest quality of life and/or well-being.

Dangerous Medication Interactions in Long-Term Care

Warfarin, NSAIDs
Warfarin, Sulfa Drugs
Warfarin, Macrolides
Warfarin, Quinolones
Warfarin, Phenytoin
Ace Inhibitors, Potassium Supplements
Ace Inhibitors, Spironolactone
Digoxin, Amiodarone
Digoxin, Verapamil
Theophylline, Quinolones
Source: HCAN (2007) [www.amda.com/www.ismp.org]

Top 10 Drugs Reported as Causing Harm Through Medication Error

Insulin Warfarin
Morphine Furosemide
Hydromorphone Dalteparin
Heparin Metoprolol
Fentanyl Ramipril
Source: ISMP Canada 2006

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