TIP OF THE WEEK

Safe Medication Prescribing Principles

 

The elderly represent only 12 percent of the population but consume about 30 percent of prescription medications, placing them at higher risk for complications due to drug-on-drug interactions.[1]

 

One way to combat complications with medications is to establish prescribing principles within your organization, system, or community. In Oklahoma, the SPOkE (Safe Prescribing in the Oklahoma Elderly) program was initiated to increase compliance with the Beers Criteria, a guide for medication safety in the elderly.[2] The SPOkE prescribing principles include:

1. At each encounter, assess your patient/resident’s current drug regimen (including prescription, OTC, and alternative medications) before prescribing a new medication.
2. Determine if any current medications are on the Beers List and could be gradually switched to an alternative, safer therapy.
3. For medications that have no alternative, monitor your patient/resident closely for adverse effects.
4. Prescribe as few drugs as possible. Consider if one drug could be prescribed to treat two conditions.
5. Avoid adding new drugs to treat side effects of current medications.
6. “Start low and go slow” with new medications, and increase only as needed.
7. Discuss potential side effects and treatment adherence with patients/residents, families, and caregivers.
8. Decide if drug therapy is needed or if a non-drug alternative exists.
9. Determine how often medications on the Beers List, such as diazepam or propoxyphene, are used in your elderly patients through chart review or an electronic medical record. Develop systems or reminders to decrease the use of these medications.
10. Understand the side effect profile and pharmacokinetic properties of medications you’re prescribing to elderly patients.
11. Discontinue medications without a known benefit or clinical indication.
12. If a patient/resident develops a new or unexplained medical problem, consider an ADE (adverse drug event) as a potential cause.
13. Work as an interdisciplinary team of physician, pharmacist, and nurse to optimize patient/resident outcomes and safety.
14. Provide patients/residents and families with written information about their medications.

 

Sources:

1. Factors Associated with Medication Use Among the Elderly. Last accessed 7/2/08. http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102273472.html
2. Safe Prescribing in the Oklahoma Elderly (SPOKE) Brochure. Last accessed 7/2/08. http://medqic.org/dcs/ContentServer?cid=1176726298040&pagename=Medqic%2FMQTools%2FToolTemplate&c=MQTools

 

 

 

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