In recent years, our long-term care industry has witnessed a concerning trend—the rising prevalence of polypharmacy, the simultaneous use of multiple medications by an individual. While medications undoubtedly play a crucial role in managing various health conditions for our aging population, when those prescriptions are not monitored or cross-checked, it can lead to complications and even severe consequences for residents in long-term care communities. At Heartland Pharmacy, we are aware of the dangers of cross-prescribing, and we employ strategies to prevent its detrimental effects.
What is polypharmacy?
Polypharmacy occurs when an individual takes multiple medications, often prescribed by different healthcare providers, without proper coordination or oversight. Our aging population is particularly susceptible to polypharmacy as they are more likely to have multiple chronic conditions requiring medication management. However, the cumulative effect of multiple drugs can lead to adverse drug interactions, increased risk of falls, cognitive impairment, and reduced quality of life.
What are the cumulative effects?
1. Adverse Drug Reactions (ADRs): The simultaneous use of multiple medications significantly increases the risk of adverse drug reactions. ADRs can range from mild side effects to life-threatening conditions, such as organ failure or severe allergic reactions. Because there is a complexity to managing multiple medications, the likelihood of overlooking potentially dangerous interactions is exacerbated.
AHA Statement on Medication Errors in Acute Cardiac Care: Half of all cardiac arrests are preventable. 44% of those are due to medication errors and toxicity. Up to 27% of deaths from MI are preventable.
2. Increased Fall Risk: Taking multiple medications increases the risk of resident falls even in a long-term care setting. Certain medications, especially those with sedative or drowsiness-inducing properties, can impair balance and coordination. Even more critically, the side effects of different medications may interact, further compromising mobility and increasing the likelihood of falls.
3. Cognitive Impairment: Polypharmacy has been linked to cognitive decline and an increased risk of developing conditions such as dementia. Some medications have anticholinergic effects, negatively impacting cognitive function, memory, and attention. Combining multiple drugs with such effects can worsen cognitive impairment in vulnerable individuals.
How is Heartland Pharmacy combating polypharmacy?
1. Ongoing Medication Review: Regular medication reviews conducted by the dedicated pharmacy team help identify unnecessary or redundant medications. By streamlining the medication regimen, Heartland Pharmacy and the entire care staff team can reduce the risk of polypharmacy and identify potential interactions or adverse effects.
2. Interdisciplinary Collaboration: Improved communication and collaboration among healthcare providers, including doctors, nurses, resident advisors, and Heartland Pharmacy, are vital in preventing polypharmacy. Coordinated efforts can facilitate a comprehensive understanding of a resident’s medication history, avoid duplication, and minimize unnecessary prescriptions. Implementing Serenity, a single conversation platform for internal community staff allows streamlined communication between Heartland Pharmacy and external staff.
3. Patient Education: It is crucial to educate long-term care residents and their families about the risks associated with polypharmacy. Encouraging active involvement in medication management, including understanding each medication’s purpose and potential side effects, empowers residents to make informed decisions.
The status quo is not an option. Nothing will change unless we work systematically to develop new processes for medication review and communication with residents, families, staff, and prescribers to reduce medications and clarify goals of care.
-Dr. Jonathan Evans, Medical Director, Century Park
4. Regular Wellness Reviews: Conducting periodic reviews of a resident’s medication regimen can identify any changes in health status, allowing healthcare providers to adjust prescriptions accordingly. This proactive approach ensures that medications remain appropriate and necessary over time, minimizing the risk of polypharmacy. Heartland Pharmacy has a dedicated PCAT for each community and resident. They are well-versed in each resident’s medication regimen and general lifestyle.
5. Embracing Non-Pharmacological Interventions: While it may seem contrary to a pharmacy’s business philosophy, Heartland Pharmacy embraces drug-reduction efforts. In fact, we encourage our residents to consider pharmacogenetic testing (PGX). PGX provides data about your genes to help your healthcare provider choose the medication and dosage that is the best fit for you. This precision approach often allows for med-reduction and overall increased wellness, particularly in a long-term care resident.
While polypharmacy poses a significant threat to the well-being and safety of long-term care residents, Heartland Pharmacy is taking a proactive approach. As a pharmacy that is dedicated to making a difference in the lives of the individuals we serve, our team employs proactive strategies, including medication reviews, interdisciplinary collaboration, resident education, and non-pharmacological interventions. By prioritizing medication safety and optimizing treatment plans, we can collaboratively combat the dangers of polypharmacy and improve resident care.