What does “medication management” really mean for residents or clients of an aged care service or home and community care service?
The sector domain doesn’t make a difference when considering the needs of an older body and the nine rights of medication management. The ageing body is unfortunately for us all, summed up by the fact we get drier, shorter, become “more podgy”, and therefore need less medicine doses.
Because of the decrease in total body water of the older body, a ‘usual’ medicine dose will result in a higher concentration of medicine distribution as there is less fluid volume to dilute the medicine. This means smaller dosages are required, and incidentally, this also applies to alcohol, for example, there is an increased sensitivity to alcohol and less body fluid to dilute the intake.
Many of the adverse drug reactions experienced by older people result from the prolonged higher tissue levels caused by decreased excretory capacity of the kidneys and skin and the higher fat volume in the older body where medicines may be stored. This means medications may linger for longer. Examples of drugs affected are Digoxin, Beta blocking agents and antibiotics – especially amino-glycosides such as Streptomycin and Gentamicin.
Caution is also warned when using diuretics as they may precipitate an electrolyte imbalance, for example, hyponatremia and hypocalcemia if too much fluid is excreted too quickly. Interstitial fluid volume per unit is lower and lean tissue mass per unit of body weight is reduced. There is a loss of bone minerals as we age and some reduction of diffusion capacity at the alveolar membrane with the effective mass of the kidney reduced and the glomerular filtration rate reduced, meaning medicine excretion is slower.
Despite these age-related changes to the internal biological homeostatic mechanisms, the pH of blood is usually maintained within normal limits and only impaired when extra stress (such as physical illness) is present. But there is always a dehydration risk when an older person doesn’t remember to drink or cannot obtain their own.
Medication management requires addressing at least nine rights. We need to ensure the right person, medicine, route, time and dose. We also must have the right documentation available to know what else to consider before prescribing, ensure the medicine has the right action for the older person’s body, that the medicine is in the right form (consider Dysphagia), and is achieving the right response.
Medication management software systems can ensure these rights are considered and risk management strategies are built into the design of the system.
Considerations include ensuring the person’s photo is current and available everywhere throughout the admin process. Ensuring a prescription is captured and communicated to staff in real-time so that new doses, new medicines, ceased details and changes are immediately available to staff is critical to ensuring no misadventures with medicines.
Ensuring generic medicine names are used and referred to minimises mistaken medicine identity. Allergies and sensitivities need to be upfront and obvious. Ensuring the right medicine route and form is clearly presented for staff administering medications, minimises the risk of an older person choking on a medicine – especially when choking remains one of the highest causes of death in older persons.
The right dose must be supplemented with ensuring the right frequency of the medicine is clearly articulated with the right times of administration alerted to staff for medicine consumption. It’s just as important to ensure the right nursing, clinical and medical documentation is up-front and central for administering staff so they know what are the medical diagnoses, but also the persons’ communication ability.
Whether older persons are in residential care or are supported in their own homes or the community, they need support that considers every aspect of their life when considering medication management, their lifestyle, their home conditions and situations.
Gerontology and medication management are not just about medical management and tablets. Such support requires a detailed and considered approach of the person’s social situation and the reason a prescription is required, with relevant instructions for staff administering medications so that they get it right, every time. A system that alerts, advises, reports and prompts, one that considers the entire nursing process of assessment, planning, intervention and evaluation, minimises risk.
So next time you think of medication management, take the time to consider all nine rights, the ageing body and how your procedures and systems have actually considered all these concepts.
For more information please visit https://www.leecare.com.au/
