Try it: 'I don't know'

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Recently, in McKnight's Long-Term Care News you may have read that the number of persons needing treatment in a hospital after an adverse drug reaction grew an overwhelming 52% between 2004 and 2008, and more than half of the errors involved seniors over the age of 65.

The adverse events were caused either by taking or being given the wrong medication or dosage. Now get this, some of the categories of medicines causing injury or illness were painkillers (not only narcotics), blood-thinners, and heart and blood pressure medicines.

Gee, know any residents in your facility on a combination of those? OK, so that's basically the majority of your residents. 

But should they be on all that? Let's face it, often there isn't any solid evidence as to why a resident is on a medication. Many times, they came from the previous location on a bucket load of medications and they stay on them. Maybe they came from the hospital on a PPI and we just assumed they had GERD and in our overzealous need to get that admission POS form ready for the call to the new attending, we fill in the “why” the resident is on the drug based on assumption. (Drug, strength, route, administration time(s), rational for drug — “why”).

Way too often the long list we get from the hospital transfer has everything but the “why.” And we know the attending is going to ask and we can't say “I don't know” — right? WRONG!

We have to stop that practice. (I know, I know — we just want to help, it's our nature.) But it's in the resident's best interest that if we can't find out the “why” for the practitioner, then he or she needs to come in and find out by conducting a comprehensive H&P. A radical thought?

But we can help by introducing the practitioners to the DITTO tool. What's that? It's the Drug Improvement Through Treatment Optimization. It's really a cool concept and one recently supported by the American Medical Directors Association.

The first step is sorting all of the patient's existing medications (including herbal remedies and other nonprescriptions) into one of three categories. Medications prescribed to cure a specific condition (such as antibiotics for an infection), medications prescribed to prevent complications of existing, usually chronic diseases (such as medications to lower blood pressure) and medications prescribed to relieve symptoms (such as pain medications).

Then, those are subdivided into four categories of vital (those that are keeping a condition under control and whose discontinuation could result in death), important (are those that, if discontinued, would cause a significant deterioration of function), optional (usually prescribed as needed), or not indicated (such as that PPI that was just used in conjunction with a medication that was given in a hospital but the patient is no longer on-clinically indicated at one time but no longer needed).

So take a deep breath. It's OK to say, “I don't know.” But when you come in to figure out what medications this resident should be on, we have a tool that can help you (recommended by AMDA).

Just keeping it real,

 

Nurse Jackie

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The Real Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.

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