Medication compliance and safety are serious topics in healthcare in general, and home care specifically. Fortunately, it is a topic that is gaining attention in the research world. Unfortunately, all we know so far is that it is a complex issue with few empirically supported interventions. A recent review of 182 randomized controlled trials that aimed to improve medication adherence found that only 5 of the 182 interventions reported outcomes of both improved medication adherence and improved clinical outcomes (Nieuwlaat et al., 2014). In view of studies that have found people take less than half of their prescribed doses of medication, a great deal of more research is needed to improve adherence to prescribed drugs. Missed doses are just one of the problems associated with medication safety. Adverse drug events result in more than 700,000 emergency department visits per year and 120,000 people need to be admitted to the hospital as a result (Centers for Disease Control and Prevention, 2014). In a large study by Budnitz et al. (2011), nearly two-thirds of hospitalizations for adverse drug events were due to unintentional overdoses, with warfarin, insulin, oral antiplatelet medications, and oral hypoglycemic agents being the most commonly reported drugs associated with adverse events.
Any home care clinician can tell you that finding and keeping accurate and up-to-date medication lists in the home is challenging. Patients are routinely cared for by a primary care provider as well as specialists, and often have medications discontinued and new drugs ordered when treated in the emergency department or an urgent care center. Electronic medical records have their limitations. Even within a single medical facility, information isn't always shared across inpatient and outpatient settings. Every time a patient moves from one setting to another, important information can be lost or miscommunicated. Even in a perfect world, where an accurate medication list could be found in every home, many patients don't recognize the importance of adherence to their drug regimen. Some people stop drugs because expected side effects are mistaken to be allergic symptoms, whereas others can't afford to refill costly prescriptions.
Drug therapies have resulted in greatly improved options for the management of medical conditions. Who can imagine a world without antibiotic, antihypertensive, antidiabetic, and anticoagulant drugs? We are grateful for the seemingly miraculous cures offered today, yet with this gift comes great responsibility, both on the part of recipients of the drugs and those who prescribe, monitor and educate patients about them. All home healthcare clinicians need to be familiar with the medications that are prescribed for the patients they treat. Simple patient teaching should be reinforced by every discipline. For example, can you imagine how many fewer patients with stroke we might see if every clinician, from physical therapist, to nurse, to pharmacist, reminded patients to never stop taking antihypertensives without the direction of their primary care provider? The decrease in emergency department visits for bleeding if every clinician reminded patients taking warfarin of the potentiating effects of aspirin products? The potential decrease in the incidence of hypoglycemia if every clinician reminded patients who take insulin of the need to coordinate their meals in relationship to insulin administration? I urge you to read the Consult PRN column in this issue. Author Cindy Farris answers a question about the teach-back method of ensuring that patient education is effective.
This month's issue of Home Healthcare Now brings two feature articles related to drug therapy. Dr. Barbara Freeland and colleague wrote an excellent update on drug therapy for treatment of Type 2 diabetes. Recent years have seen an explosion of new categories of drugs to treat diabetes, as well as new drugs within existing categories. For example, new long- and rapid-acting insulins have allowed patients to better meet basic metabolic insulin requirements as well as the need for additional mealtime insulin, while decreasing the incidence of hypoglycemia. Author Raeann LeBlanc conducted and reports on a quality improvement project to improve medication safety among community-dwelling older adults. The Institute for Safe Medication Practices (ISMP) column provides an excellent reminder about drug errors that can result from the use of alphanumeric symbols when prescribing drugs. For example, when a drug name ends with the letter l, it can appear to be a numeral 1, altering the correct dose of the prescribed drug. On the other hand, a lower case l can be mistaken for an upper case I, altering the name of the prescribed drug.
Finally, I want to remind you that June 11-18 is National Nursing Assistants Week. We at Home Healthcare Now want to thank the many home healthcare assistants that do so much for home care patients everywhere! You are so very appreciated.
With best regards,
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