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Week 2 Polypharmacy Discussion.
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Week 2 Polypharmacy Discussion.
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Week 2 Polypharmacy DiscussionPolypharmacy is a common concern, especially in the elderly.
• List the definitions of polypharmacy you encounter in your readings. There is more than one.
o Polypharmacy, the use of multiple pharmacies (in this case providers and self-
prescribers) is a public health concern. Multiple prescribers, use of over-the-counter
medications, and readily available supplements are all challenges of prescribing for
older adults ( Chamberlain College of Nursing, 2018).
o Polypharmacy, multiple providers and prescribers, adherence and cost, use of
over- the-counter medications, and readily available herbals and supplements are all
the challenges of prescribing for older adults (Terrery & Nicoteri, 2016).
o the use of multiple medicines, commonly referred to as polypharmacy is common in
the older population with multimorbidity, as one or more medicines may be used to
treat each condition (Masnoon, Skakib, & Caughey, 2017).
• Discuss three risk factors that can lead to polypharmacy. Explain the rationale for why each
listed item is a risk factor.
This is different than adverse drug reactions. ADRs can be a result of polypharmacy, and is
important, but ADRs are not a risk factor.
• Self-Medication. Rationale; Many patients buy their own prescribed medicine from the
chemist close to their location, and thus they are at risk of polypharmacy. Due to the
rising cost of medication patients are more likely to take medications they may have
been prescribed in the past leading to self- medication (Maher, Hanlon, & Hajjar, 2014).
• Chronic comorbidities. Rationale; instance a patient with hypertension, heart failure,
hyperlipidemia, obstructive sleep apnea, and diabetic is likely to be a subject to
polypharmacy. In which patients have multiple providers each of the providers may
still have paper charts or EMR’s in which are separate entities and do not share the
information with the patient’s other physicians regarding the visit to have continuity of
care resulting in polypharmacy (Maher, Hanlon, & Hajjar, 2014).
• Old age. Rationale; The elderly are at risk of polypharmacy since they may use both
herbal medicines and the modern medicines and also, they may have the cognitive
impairments that make them unable to make the right judgments on which drugs to
take, the right quantities and the right time (Maher, Hanlon, & Hajjar, 2014).
• Discuss three action steps that a provider can take to prevent polypharmacy.
o Reviewing of patient treatment sheet to prevent duplication of medication upon any transition
to any medical facility or even the chemist to avoid polypharmacy. The brown bag review is
having the patient bring in their medications to the visit review them and gather the medication
or have the medication history taken by the pharmacist (McGrath, Hajjar, Kumar, Hwang &
Salzman, 2017).
o Creating a follow-up plan. At the time of deprescribing a medication, develop a plan with the
patient for monitoring and assessment. Ensure that the patient understands which symptoms may
occur in the event of drug withdrawal and which symptoms may suggest the return of a
condition (McGrath, Hajjar, Kumar, Hwang & Salzman, 2017).
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, • Talk to the patient about the deprescribing process, talk with the patient about the risks and
benefits of deprescribing, and prioritize which medications to address in the process.
Prioritize the medications by balancing patient preferences with available pharmacologic
evidence (McGrath, Hajjar, Kumar, Hwang & Salzman, 2017).
• Provide an example of how your clinical preceptors have addressed polypharmacy.
o Obtain pharmacist recommendations to reduce inappropriate prescribing and
adverse drug events
o use computerized alerts to reduce serious medication errors and help prevent
adverse drug events
o Review a patient's medications to reduce polypharmacy and inappropriate prescribing
References
Chamberlain College of Nursing. (2018) NR-601 Week 2 : Polypharmacy [Online lesson].Downers
Grove,IL. DeVry Education Group.
Maher, R. L., Hanlon, J. T., & Hajjar, E. R. (2014). Clinical Consequences of Polypharmacy in
Elderly. Expert Opinion on Drug Safety, 13(1), 10.1517/14740338.2013.827660.
http://doi.org/10.1517/14740338.2013.827660
Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A
systematic review of definitions. BMC Geriatrics, 17(1), 230. doi:10.1186/s12877-017-0621-2
McGrath, K., Hajjar, E. R., Kumar, C., Hwang, C., & Salzman, B. (2017). Deprescribing: A simple
method for reducing polypharmacy. The Journal Of Family Practice, 66(7), 436-445.
Terrery, C. L., & Nicoteri, J. A. L. (2016). The 2015 american geriatric society beers criteria: Implications
for nurse practitioners. The Journal for Nurse Practitioners, 12(3), 192-200.
doi:http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.1016/j.nurpra.2015.11
Hi Sara,
Wonderful work with the polypharmacy discussion!
As we go through each week, I'll be posting additional questions for
discussion in bold- faced font. For participation purposes (to achieve full
points), the bold-faced font questions will need to be answered in a scholarly
manner (with evidence-based support).
A question for further discussion... next week, we'll be discussing geriatric
assessment tools more in depth. (i.e. PHQ-9 questionnaire for depression
assessment). What geriatric assessment tool would be beneficial to help
minimize or prevent polypharmacy?
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