Medication Risk: Discharging Seniors
By Nadine Salmon, BSN, IBCLC, Clinical Content Specialist AMN Healthcare
Life expectancy in the United States is at an all-time high, and the fastest-growing segment of the population is the 85 and older age group (Meadows, 2006 in RN.com, 2009). Many seniors, (over the age of 65 years), suffer from multiple chronic illnesses that require complex medication regimes. Exacerbations of these illnesses, previously undiagnosed ailments or injuries sustained during falls or other accidents may necessitate admission to an acute care facility. During hospitalization, providers re-evaluate the medication profile and frequently prescribe new medications upon discharge. Nurses in the acute care setting play an important role in preparing elderly patients and their caregivers to administer and monitor medication therapy safely and effectively (RN.com, 2009).
A recent study conducted in Canada by Chaim Bell and colleagues found that senior citizens with chronic medical issues often leave the hospital without prescriptions for the medications they need. This could lead to an increased risk of readmission, perhaps even result in a fatality (Reuters, 2011).
The researchers examined the medical records of nearly 400,000 elderly people in Canada to see how often they left the hospital and then failed to renew prescriptions. The study targeted five long-term medications including cholesterol-lowering statins, blood thinners and asthma inhalers.
In this study, published in the Journal of the American Medical Association, researchers looked at records from 1997 to 2009, and compared those who'd been admitted to a hospital with those who hadn't. For the blood thinners, which include aspirin, as many as 19% of the seniors who had been hospitalized failed to get a renewed prescription within a three month period. By contrast, fewer than 12% of non-hospitalized seniors failed to get a renewed prescription. For the other medications, the difference was less pronounced but still there, especially for those patients who were readmitted to the intensive care unit.
In most cases, the erroneous discontinuation of prescriptions after discharge is unintentional, but the effects can be devastating; the researchers found that patients who discontinued statins and blood thinners had a slightly higher risk of dying or being readmitted to the emergency room within 12 months of discharge. Better communication and more effective discharge planning are essential preventative measures to put in place. And while the use of electronic medical records may help, nurses need to step forward and take a more active role in managing medication therapy during the discharge process.
RN.com now offers a 4 contact hour continuing education course for nurses on medication administration for the elderly. Click here for a preview of this course or visit lms.rn.com for other course offerings.
Reuters (2011). Many seniors leave the hospital without their meds. Retrieved from: http://www.reuters.com/article/2011/08/26/us-seniors-idUSTRE77P0F320110826
RN.com (2009). Administering Medications to the Elderly, Part 3: Discharge Planning. Retrieved from: http://lms.rn.com/main.php?uniq=154130&command=manage_courselist&data[courselist][id]=1527&data[submit_value]=Display Entry