These tips can aid nurses in medication monitoring
These tips can aid nurses in medication monitoring
Helping elderly patients manage medications
The role of home health nurses in monitoring medications for elderly patients is a complex one. Nurses must have a basic understanding of the physiological effects of drugs and how those drugs interact with each other. But that’s just the beginning, says Helen Poole, BSN, MPH, president of HK Poole & Associates in Cary, NC.
They must be watchdogs for patients who may juggle multiple medications from a variety of doctors. Often, they must be diplomats, finding ways to advocate for the patient’s well- being with physicians and with the patients themselves.
"As home health nurses, we really have a big advocacy role to play on behalf of our patients because most internal medicine and general practitioner/family practice people are not geriatric-trained," Poole says. "They don’t tend to think about the whole picture of the patient. As home health nurses, we’re very good at that. We see the person in their home environment, and we see all the things that are going on and that physician doesn’t."
Training home health staff to be alert to problems of overmedication and cross-reactions can make the difference in a senior who is alert and active and one who is hobbled by medications that are supposed to help, Poole says.
As an example, she describes one elderly woman formerly in her care who was taking 15 different drugs. "This lady was not in very good shape," she says. "I felt like it was way too many medications." The woman finally saw a physician who put her in an institution for two weeks, to wean her off of her medications.
"She walked out the door a different person with four medicines," Poole says. "The other doctor was treating symptom after symptom, and the second physician was looking at the whole picture — what was really necessary for an 85-year-old lady."
When taking on a patient, the nurse can be hampered by lack of knowledge of what a patient is actually taking because the referring physician may not know about medications prescribed by other doctors.
"A patient can go from one doctor to another doctor, or they may have an orthopedic doctor because of their arthritis or they’ve had knee surgery, and they also may have their internal medicine doctor," Poole says. "None of those doctors may know what’s going on, and they may prescribe other things."
Check the medicine cabinet
When taking on a patient, she says it’s important for a nurse to do a comprehensive check of all the medications a person is taking. That begins with verifying what the patient’s physicians have prescribed. Ask the patient for the names of any doctors he or she is seeing and any drugs currently prescribed. Check with all of those physicians to make sure they all know all of the medicines the patient is taking.
Poole advises that a health worker check the patient’s home to see if there are other medications present. "If the nurse doesn’t feel comfortable, then I encourage the nurse to ask family members to do what I call search and seizure,’" she says. "What happens with a lot of these older folks is that they are hoarders. They hide medication that they’ve been on before. It’s probably expired and maybe has no effect anymore, but it may, and that effect plus something new may be the thing that’s keeping them zonked out."
She says someone should check pocketbooks, bedside stands, and medicine cabinets and get rid of any expired medications. Over-the-counter medicines should go as well.
"People will go in and get things over the counter until they’ve got all kinds of stuff that they’re taking that nobody knows about," she says. "It’s really a cleaning out process until you know that [current prescriptions] are the only things you need in the house."
When discussing medications with physicians, nurses shouldn’t look just at how many drugs a patient is taking, but at when and how they’re being taken. For example, if one drug is taken at a different time of day than all of the others, it may be possible for the physician to change the schedule so they all may be taken at once.
A master list of medications is a useful tool for all of the patient’s caregivers, Poole says. She lists the drugs and tapes a sample of each to the sheet, in case the pills are spilled and mixed up.
There are myriad tips that nurses use to help patients remember to take their pills. Pill boxes with individual compartments for each day’s dose are fine, Poole says, but have their limitations. "The pill box is only as good as somebody lifting the little lid and taking the pill out," she says. "It assures, hopefully, the right dosage for that patient, but what’s going to remind a patient who may have a slight dementia to remember?"
Poole says one nurse came up with a memory device to help a patient who always watched a soap opera at the same time every day. "What she told her to do is to take the pill when Oprah Winfrey [a show that follows the soap] comes on."
Respect your patients
If a nurse suspects that a patient isn’t taking medication as needed, it may be necessary to count pills or use some other method to verify what’s being taken. When a problem is discovered, Poole says it’s important to discover the root cause, whether it’s forgetfulness, a patient not believing the pills are needed, or some deeper problem such as financial constraints.
Poole says affordability is a big issue with seniors, many of whom are on fixed incomes and dealing with health plans that may not pay much toward prescriptions. "These folks who are 75 to 80 years old, who’ve lived through the Depression, have a lot of pride. Saying to somebody that they’re not able to pay for [medications] is a big deal. It’s important to them not to take handouts from people."
A nurse needs to approach the issue cautiously, respecting the patient’s feelings. "You have to develop trust over time, and hopefully you can sit down and have a discussion and try to say, Is there a reason if you’re out of these that you’re not going to get them?’ It’s a sensitive issue, and is somebody going to reveal that if they don’t feel comfortable?"
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