According to estimates from a 2006 report from the Institute of Medicine, Preventing Medication Errors, a patient is at risk for one medication error per day, and about one-fourth of related injuries are preventable. These preventable deaths result in not only a loss of life to patients and distress to families, but billions of dollars in health-care costs. The report noted that a strong provider-patient partnership is key to preventing medication errors. Nurse practitioners and physician assistants are well-positioned to help avert medication-related mistakes.
The elderly are considered highly vulnerable to drug-related adverse effects, in part because they use numerous medications, often in inappropriate doses relative to their age and physiological state. Elderly individuals might not adhere properly to a medication regimen due to changes in their mental or physical status; this places them at risk for medication overuse, non-use, or various scenarios between these two extremes.
Theoretically, medication problems can afflict anyone who is being seen by more than one health-care provider and receiving various prescriptions, and/or anyone who is taking medications they haven’t told their health-care providers about. An important consideration in discussing polypharmacy (the use of many medications) is the use of alternative therapies, such as herbal remedies. People taking alternative therapies may not think to mention these items to their providers, or may be reluctant to share the information. Considering that Americans spend a near fortune on unregulated herbal supplements with unknown effectiveness, presumably a significant number of the patients we see are using these remedies.
Clinicians face a challenge in broaching the subject of alternative therapies with a nonjudgmental attitude; this is necessary in order to obtain an accurate and complete treatment history from patients. Open communication may provide a pathway to establishing a positive relationship with a patient, allowing the clinician to then offer helpful instruction regarding medications. For example, a provider may need to educate the patient as to the potentially harmful interactions between certain herbal remedies and a given treatment regimen.
The nurse practitioner and physician assistant play important roles in managing medication-related health and safety issues for patients. Advanced-practice personnel are in an ideal position to collect health information from patients, including a medication history. They can also coordinate care with other providers and review current treatment plans, including drugs prescribed by specialists, with appropriate patient consent.
Nurse practitioners and physician assistants may be the most consistently present practitioners for a patient and family amid a variety of specialists. These clinicians can serve as a point of contact in collecting, organizing, and summarizing a patient’s medication data. This information could prove vital to a health-care team and help deter adverse medication events. Resources such as the Beers Criteria are available to help providers determine appropriate medications for the elderly.
A comprehensive medication history is also beneficial when assessing and diagnosing patients, particularly if providers have access to the most current health record. n