Medication

 

OVERVIEW

The 20th century has seen unimaginable advances in pharmaceutical sciences and medication therapies. Nurses are responsible for the safe delivery and appropriate patient education for older adults who may be on several medications, which sometimes can interact in ways that are not therapeutic. The purpose of this protocol is to give a high-level summary of critical issues in safe medication management for older adults across the care continuum.

Nurses are responsible for safe medication management and knowledge related to:

A. Detection and reporting of adverse drugs events (ADEs) including drug–drug interactions

B. Medication reconciliation

C. Medication adherence

D. Detection and reporting drug–disease interactions

E. Pharmacokinetics

F. Pharmacodynamics

G. Beers Criteria updates

 

NURSING CARE GOALS

A. Optimize medication safety and effectiveness.

B. Optimize use of computerized provider order entry (CPOE) and decision support systems.

C. Use effective teaching strategies and document patient and family understanding.

EVALUATION/EXPECTED OUTCOMES

A. Patients and families will:

  1. Verbally express understanding of safe medication management
  2. Describe an understanding of their medication regimens upon discharge from the current care setting
  3. Explain the importance of keeping an updated medication list
  4. Demonstrate how to use online portals to follow medication changes
  5. Engage in medication decision-making related to what matters to them

B. Healthcare providers will:

  1. Use prescribing practices that document indications for initiation of new drug therapies and maintain a current medication list that includes those medications prescribed by others
  2. Use a range of health interventions, including nonpharmacological and complementary therapies as appropriate
  3. Evaluate and resolve medication-related problems in a timely manner
  4. Maintain professional knowledge that is current and evidence-based
  5. Engage the interdisciplinary team in medication safety programs (e.g., pharmacist, geriatrician, geriatric/gerontological, psychiatric clinical nurse specialist, nurse practitioner, consultation-liaison service, social worker, case manager, interdisciplinary team)

C. Institutions will:

  1. Ensure a culture of safety that encourages safe medication practices and disclosure when an ADE occurs
  2. Provide education to healthcare providers regarding prevention, identification, and reporting of ADEs
  3. Track and report morbidity and mortality related to medication problem
  4. Monitor and intervene in iatrogenic medication effects for continuous quality improvement (CQI)
  5. Ensure education related to safe medication management is available to all relevant clinician groups

RELEVANT PRACTICE GUIDELINES AND RESOURCES

A. ASHP Guidelines on Medication Errors: https://www.ashp.org/news/2018/10/02/ashp-publishes-guidelines-on-preventing-medication-errors; https://academic.oup.com/ajhp/article-abstract/75/19/1493/5139896?redirectedFrom=fulltext

B. CDC: Adverse Drug Events: http://www.cdc.gov/MedicationSafety/program_focus_activities.html

C. Drugs With Potentially Serious Drug–Drug Interactions: http://www.merckmanuals.com/professional/clinical_pharmacology/factors_affecting_response_to_drugs/drug_interactions.html#v1108519

D. FDA: Medication Errors and Safety: http://www.fda.gov/Drugs/DrugSafety/MedicationErrors/default.htm

E. Institute for Safe Medication Practices offers webinars, lectures, and other programs related to safe medication practice, including reducing errors and identifying high risk abbreviations: www.ismp.org

F. Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Reconciliation: https://www.ahrq.gov/patient-safety/settings/hospital/match/index.html

G. Merck Manual Professional Edition: https://www.merckmanuals.com/professional?&network=x&matchtype=&keyword=&creative=&device=c&devicemodel=&placement=&position=&campaignid=18699200289&adgroupid=&loc_physical_ms=9067609&loc_interest_ms=&gclid=Cj0KCQiA5NSdBhDfARIsALzs2EAGpGpV6aHLYDm_4yxib42IQv7PkV7TAHPb26BFDKBIx8dgxTfWfBcaArbMEALw_wcB&gclsrc=aw.ds

H. National Action Plan for Prevention of ADEs. (2014). U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. National Action Plan for Adverse Drug Event Prevention. Author: http://www.health.gov/hai/ade.asp

I. U.S. Food and Drug Administration: http://www.fda.gov/

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Updated: January 2025

Boltz PhD, RN, GNP-BC, FGSA, FAAN, M., Capezuti, PhD, RN, FAAN, E.A., & Fulmer PhD, RN, FAAN, T. T. (2025). Evidence-Based Geriatric Nursing Protocols for Best Practice (7th ed.). Springer Publishing. Retrieved December 17, 2024, from https://www.springerpub.com/evidence-based-geriatric-nursing-protocols-for-best-practice-9780826152763.html#tableofcontents

Chapter 19, Brandt, N., Morton, G., Huang, J., Jones, A. & Fulmer, T.T. (2025) Medication Management in the Older Adult Across Care Settings

 

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