Medication Errors in The Elderly
Number of Medication Errors
The rate of medication errors in the elderly is higher than in any other age group. More than one third of the medication errors that occur involve patients 65 years and older. There is no single cause for the problem--and no single solution either--it is therefore very important that every healthcare provider, doctor, pharmacist, nurse, and medical assistant realizes the importance of medication error detection, reporting, evaluation, and prevention, and makes preventing errors their own personal goal!
Consider the following:
Older people tend to have more long-term illnesses than younger people, such as arthritis, diabetes, high blood pressure, and heart disease. It is common that they take combinations of different medications for many ailments.
Misuse of Medications and Risks
When prescribed and taken appropriately, drugs have many benefits: They treat diseases and infections, help manage symptoms of chronic conditions, and can contribute to an improved quality of life. But medicines can also cause problems.
High blood pressure, for example, is often treated with several different drugs. Many older people have multiple cardiovascular risk factors--high blood pressure, diabetes, abnormal cholesterol--and will often need multiple drugs to treat them. Unless supervised by a doctor, however, taking a mixture of drugs can be dangerous. For example, a person who takes a blood-thinning medication should not take it with aspirin, which will thin the blood even more. And antacids can interfere with absorption of certain drugs for Parkinson's disease, high blood pressure, and heart disease. Before prescribing any new drug to an older patient, a doctor should be aware of all the other drugs the patient may be taking.
Another example are heparin and warfarin. These are medications whose use or misuse carry ignificant potential for injury.
Subtherapeutic levels can lead to thromboembolic complications in patients with atrial fibrillation or deep venous thrombosis, while supratherapeutic levels can lead to bleeding complications.
These medications are commonly involved in adverse drug events for a variety of reasons, including the complexity of dosing and monitoring, patient compliance, numerous drug interactions, and dietary interactions that can affect drug levels. Strategies to improve both the dosing and monitoring of these high-risk drugs have potential to reduce the associated risks of bleeding or thromboembolic events.
Factors Affecting Medication Response
Age
Weight
Gender
Ethnic background
Physical health
Psychological status
Environmental temperature
Amount of food in stomach
Dosage form
R ules of distribution of medicine
Use the rule of 5 R!
The “Five Cs/Rs”:
Correct/Right Patient/Child
Correct/Right Medicine
Correct/Right Dose
Correct/Right Time
Correct/Right Route
Check exp. date, name, dosage, doctors prescription, evaluate its looks, give to the patient, mark in the list of prescriptions, put the signature.
Per os medicine should been taken under the nurse supervision.
Applying of narcotic medicine only in doctor presence, history case marks, list of prescriptions, journal of narcotic medicine account.
"Before food" - 15-30 min. "After food" - 15-30 min. On an empty stomach (vermicide, purgative) in the morning. Somnolent – 30 min before sleep.
Nurse should told about side effects.
Tablets that don’t have divide line cant been divided.
Not possible:
Keep medicine with disinfectant solutions.
Distribute medicine without prescription, make changes, put pills into the boxes preliminary, change or put away from drug store package.
The administration of a medicine is a common but important clinical procedure. It is the manner in which a medicine is administered that will determine to some extent whether or not the patient gains any clinical benefit, and whether they suffer any adverse effect from their medicines. For example, intravenous furosemide administered too quickly can cause deafness; oral penicillin given with food will not be well absorbed; over-application of topical steroids will cause thinning of the skin and may lead to systemic side-effects.
Two main factors determine whether or not a drug will reach its intended site of action in the body:
The bioavailability of the drug;
How the drug is given (route of administration).
Bioavailability
Bioavailability is the proportion of an administered drug that reaches the systemic circulation and is therefore available for distribution to the intended site of action.
Drugs that are given by direct injection are said to have 100% bioavailability. Some drugs that are particularly well absorbed by the gastrointestinal mucosa may have bioavailability comparable to that of an dose – for example the antibiotic ciprofloxacin. Most drugs do not have this availability by the oral route so the dose given orally is usually higher than that given parenterally. For example, the beta-blocker propranolol when given orally is administered in doses of 40mg and above. The equivalent dose is 1mg.The route of administration and its formulation (tablet, capsule, liquid) can clearly influence the bioavailability of a drug.
The main and side effects of the medicines are distinguish.
The main action of medicines, when it acts according to the purpose of prescribing, and side effects, when preparation negatively influences on the organism and appear as:
intolerance of medicines (so-called idiosyncrasy) with allergic reactions, apeaaring of some pathology (for example, candidosis at the using of antibiotics);
tolerance (habituation of medicines that are taken for a long time, for example, after prolonged treating with nitroglycerine its efficiency considerably falls and the grater dose of this medicine is needed to attain medical effect. It concernes also purgative and soporific.
The therapeutic action of any medicinal matter appears only at introduction of its certain amount. Taking into account there are such doses:
Therapeutic dose: (average therapeutic) is the ordinary dose of medicinal preparation, that vary upon the age, sex of patient, physiology state of organism, presence of other diseases. Thus single and daily doses are distinguished. the usual dose or average dose it is the amount needed to produce the desired therapeutic effect
Dosage range: A term that applies to the range between the minimum amount of drug and the maximum amount of drug required to produce the desired effect.
Minimum dose: The least amount of drug required to produce a therapeutic effect.
Maximum dose: The largest amount of drug that can be given without reaching the toxic effect.
Toxic dose:The least amount of drug that will produce symptoms of poisoning.causes poisoning of organism;
Minimum lethal dose: The least amount of drug that can produce death.
mortal dose causes death of patient.
In case of prescribing of few medicines the potentiation (strengthening of action) of medicinal preparations can appear; incompatibility of medicinal preparations: chemical (simultaneous setting of preparations that have acid and alkaline reactions), pharmacological (opposite influence on the same organ or their functions have been taken at ones).