Since many, in fact, the majority, of nursing home residents are on some form of prescription drugs, they need to have adequate supervision of the quantity and in what combinations their drugs are administered. One of the many areas that are under scrutiny in the nursing home industry is how medications are managed. The amounts of medications being administered to patients in nursing homes are high. A study done on 1106 residents of 12 different homes showed an average of 7.2 medications per patient. Another study showed similar results with 800 residents using an average 8.1 medications. With residents on so many drugs, it is paramount that they are being properly monitored. Unfortunately, a recent case in California points to the fact that this is not always the case. Recently, a nurse in California was convicted of giving a drug overdose to one of her 84-year old patients in a nursing home in Orange County. The nurse was also found guilty in medication abuse with six other patients, who were given morphine even though it was not prescribed to them. The nursing home was also found be to guilty of several violations including their failure to protect their patients from medication errors and receiving non-prescribed narcotics.
Adverse Drug Events (ADE’s)
With so many prescriptions being prescribed to nursing home patients, the monitoring and prevention of ADEs is of high importance. In a study published in the Archives of Internal Medicine, a case study of residents from 18 different nursing homes found that over a one year period, over half of ADEs found in patients were preventable. Over 10% of these were life threatening and .04% were fatal. The main consequences of ADEs are falls, malnutrition, dehydration, incontinence, delirium and behavior problems. It is estimated that the annual costs for ADEs in nursing homes is $7.6 billion. This is money that could be better spent on improving care and staffing within the homes. It could be argued that if staffing and care were improved, then ADEs would be greatly reduced. The main causes for ADEs are:
- Wrong medication dosage 63%
- Failing to consider drug interactions 22%
- Failure to order monitoring 83%
- Failure or delay to respond to signs of overdose 41%
Monitoring drug usage in nursing homes needs to be a top priority. Too many elderly are being put at risk with mismanagement of medication therapies. It is one more area that needs to be addressed when looking at nursing home reform and improvement.
Study on average prescriptions per patient http://www.usuhs.mil/med/geriatrics/DrugUseintheNursingHome.pdf
ADE study http://archinte.jamanetwork.com/article.aspx?volume=161&issue=13&page=1629
ADE effects http://www.amda.com/publications/caring/april2003/mederrors.cfm CA nurse