• Fulmer T, Foreman MD, Zwicker CD. Medication in older adults. In: Mezey M, Fulmer T, Abraham I, Zwicker DA, editor(s). Geriatric nursing protocols for best practice. 2nd ed. New York (NY): Springer Publishing Company, Inc.; 2003. p. 207-28. [41 references]

This is the current release of the guideline.

This guideline updates a previous version: Ensuring medication safety for older adults. In Mezey et al (Eds). Geriatric nursing protocols for best practice. Springer Publishing Company: New York.

• Adverse drug events
• Iatrogenesis related to medication problems
• Other medication-related problems

Evaluation
Management
Prevention
Risk Assessment

Family Practice
Geriatrics
Internal Medicine
Nursing
Physical Medicine and Rehabilitation

Advanced Practice Nurses
Allied Health Personnel
Nurses

• To prevent/decrease adverse drug events in older adults
• To conduct a comprehensive medication assessment
• To specify classes of medications having a high potential for toxicity in the elderly
• To identify factors that place older adults at risk for medication problems
• To present strategies to counteract some common drug-induced problems in older adults
• To promote use of an individualized plan for medication safety in an older adult

Hospitalized older adults

Evaluation

Comprehensive medication assessment, including:

1. Medical diagnoses, diseases, or health problems
2. History of previous adverse drug reaction(s)
3. Numbers and types of medications, including over-the-counter and herbal remedies
4. Length of time taking each medication
5. Last time the prescription was re-evaluated by a competent health provider
6. Proper medication administration (appropriate drug, dose, timing, and indication)
7. Deviations from prescription
8. Storage of medications
9. Intended effect(s) of medication
10. Potential drug interactions
11. Functional, sensory, cognitive, affective, and nutritional status
12. Technical problems with medication use (ability to open bottles and read labels)
13. Ability to obtain medications (how filled, cost factors, support)
14. Allergies to medications and type of reaction, adverse effects of medication
15. Understanding of drug regimen

Prevention/Management

1. A nursing plan that focuses on appropriate medication regimes for older adults
2. Education for patient and family/caregivers regarding appropriate medication management
   • Drug sheets and other written educational materials
3. Documentation of teaching strategies and follow-up with patients to determine that education was effective
4. Referral/consultation with specialist (e.g., geriatrician, geriatric/gerontological or psychiatric clinical nurse specialist, nurse practitioner, or consultation-liaison service) as appropriate

• Percentage of admissions to emergency rooms and acute care hospitals for medication-related problems
• Drug-related morbidity and mortality

Searches of Electronic Databases

Medline was the electronic database used.

200

Expert Consensus

Not applicable

Review

Not applicable

Informal Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review
Internal Peer Review

Not stated

None provided

The type of supporting evidence is not specifically stated for each recommendation.

Overall Benefits

• Decreased incidence of adverse drug events in elderly
• Improved outcomes for patients
• Improved quality of life for elderly

Specific Benefits

Patients will:

• Experience fewer iatrogenic outcomes from medications
• Understand their medication regimens

Healthcare providers will:

• Use of a range of interventions to prevent, alleviate, or ameliorate medication problems with older adults
• Document on-going comprehensive medication assessment
• Increased their knowledge about medication safety in the elderly
• Increase referrals to appropriate practitioners (e.g., geriatrician, geriatric/gerontological or psychiatric clinical nurse specialist, nurse practitioner, or consultation-liaison service)

Institutions will:

• Provide educational material related to the Beers criteria
• See decreased morbidity and mortality due to medication-related problems
• See improved documentation of medication usage
• Consider unit dose packaging to avoid incorrect medications
• Review for careful documentation of iatrogenic medication and other iatrogenic events for continuous quality improvement
• Staff will receive ongoing education related to safe medication management

Not stated

As individuals age, they may have a series of difficulties that decrease their ability to comply with medication regimens (e.g., vision impairment, arthritis, economics). The body of literature related to medication compliance in older adults is beyond the scope of this guideline, but it is extremely important to note.

An implementation strategy was not provided.

Living with Illness
Staying Healthy

Effectiveness
Safety

• Fulmer T, Foreman MD, Zwicker CD. Medication in older adults. In: Mezey M, Fulmer T, Abraham I, Zwicker DA, editor(s). Geriatric nursing protocols for best practice. 2nd ed. New York (NY): Springer Publishing Company, Inc.; 2003. p. 207-28. [41 references]

Not applicable: The guideline was not adapted from another source.

2003

Hartford Institute for Geriatric Nursing - Academic Institution

The guidelines were developed by a group of nursing experts from across the country as part of the Nurses Improving Care for Health System Elders (NICHE) project, under sponsorship of The John A. Hartford Foundation Institute for Geriatric Nursing.

Supported by a grant from the John A. Hartford Foundation.

Not stated

Primary Authors Terry Fulmer, PhD, RN, FAAN; Marquis D. Foreman, PhD, RN, FAAN; C. DeAnne Zwicker, MS, APRN, BC

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Ensuring medication safety for older adults. In Mezey et al (Eds). Geriatric nursing protocols for best practice. Springer Publishing Company: New York.

None available

None available

This summary was completed by ECRI on July 30, 2003.The information was verified by the guideline developer on August 25, 2003.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.