Medical Office Pharmacology: Review For Medical Assistant Students and Professionals
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Medication Errors in The Elderly
For medical assistants who need to brush up on certain areas in pharmacology as it applies to a medical office.
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Medication Errors in The Elderly

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 Medication Errors in The Elderly...
The need for trained medical assistants remains at an all-time high! At any given moment thousands of job offers for medical assistants and other healthcare professionals open and close! Most require knowledge of certain medical office procedures and basic principles of pharmacology.

Medication Errors in The Elderly
Number of Medication Errors
The rate of medication errors in the elderly is higher than in any other age group. More than one third of the medication errors that occur in the US involve patients 65 years and older. There is no single cause for the problem--and no single solution either--it is therefore very important that every healthcare provider, doctor, pharmacist, nurse, and medical assistant realizes the importance of medication error detection, reporting, evaluation, and prevention, and makes preventing errors their own personal goal!

Medical assistant takes notes!Consider the following:
Older people tend to have more long-term illnesses than younger people, such as arthritis, diabetes, high blood pressure, and heart disease. It is common that they take combinations of different medications for many ailments.

Misuse of Medications and Risks
When prescribed and taken appropriately, drugs have many benefits: They treat diseases and infections, help manage symptoms of chronic conditions, and can contribute to an improved quality of life. But medicines can also cause problems. The Food and Drug Administration is working to make drugs safer for older people, who consume a large share of the nation's medications. People over age 65 buy 30 percent of all prescription drugs and 40 percent of all over-the-counter drugs.

High blood pressure, for example, is often treated with several different drugs. Many older people have multiple cardiovascular risk factors--high blood pressure, diabetes, abnormal cholesterol--and will often need multiple drugs to treat them. Unless supervised by a doctor, however, taking a mixture of drugs can be dangerous. For example, a person who takes a blood-thinning medication should not take it with aspirin, which will thin the blood even more. And antacids can interfere with absorption of certain drugs for Parkinson's disease, high blood pressure, and heart disease. Before prescribing any new drug to an older patient, a doctor should be aware of all the other drugs the patient may be taking.

Another example are heparin and warfarin. These are medications whose use or misuse carry
significant potential for injury.

Subtherapeutic levels can lead to thromboembolic complications in patients with atrial fibrillation
or deep venous thrombosis (DVT), while supratherapeutic levels can lead to bleeding complications.
These medications are commonly involved in adverse drug events for a variety of reasons, including
the complexity of dosing and monitoring, patient compliance, numerous drug interactions, and dietary interactions that can affect drug levels. Strategies to improve both the dosing and monitoring of these
high-risk drugs have potential to reduce the associated risks of bleeding or thromboembolic events.

Drug Errors Common But Preventable In Elderly
Journal of the American Medical Association 2003;289:1107-1116,1154-1156.
Last Updated: 2003-03-04 16:42:06 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Harmful drug side effects and interactions are common among older people, but more than a quarter of these adverse drug events could be prevented, according to a study of Medicare recipients released Tuesday.

There are about 50 adverse drug events per 1,000 elderly people per year, and at least 13 of those are potentially preventable, the researchers estimate. One of the easiest ways to prevent some of these errors is to better educate patients about the drugs they are taking, they said.

The study shows that adverse drug events are "more common than we expected," Dr. Jerry H. Gurwitz, of Meyers Primary Care Institute in Worcester, Massachusetts, told Reuters Health. Adverse events could include anything from a skin rash to a fall to a bleeding episode requiring hospitalization.

"Nobody realized the extent of the problem before this point," Gurwitz said.
Every healthcare system that cares for elderly patients "really has to have a strategy in place for identifying adverse drug events," according to Gurwitz.
"There are very few organizations that are doing that now," he said.

Gurwitz and his colleagues tallied adverse drug events--defined as any injury caused by a medication--in more than 27,000 elderly people treated by a large medical group in New England over the course of one year.
The researchers identified 1,523 adverse drug events, about 28% of which they considered preventable. Serious, life-threatening and fatal adverse drug events, which numbered 578, were even more likely to be preventable, according to the researchers. About 42% of these more serious events could have been avoided, the authors conclude.

Drugs that were often involved in preventable injuries included heart medications, diuretics, pain medications, diabetes drugs and blood thinners. Common adverse drug events that could have been prevented included gastrointestinal side effects, kidney problems and internal bleeding.

Prescription problems often occurred when doctors prescribed a drug that interacted negatively with another drug the patient was already taking. Other prescription problems that led to adverse drug events included prescribing incorrect dosages. Problems also developed when people taking blood thinners, which can cause internal bleeding, were not monitored as closely as they should have been.

Although most adverse drug events were due to prescription and monitoring mistakes, Gurwitz said that a "substantial" proportion of preventable adverse drug events occurred when patients did not take their medicine as directed, such as refusing to take a medication or continuing to take a drug after a doctor told them to stop.
"Healthcare providers, including physicians, nurses and pharmacists have to do a much better job educating patients about the medications they are taking," Gurwitz said.

He encouraged patients to take on the responsibility of understanding the medications they are taking, including being aware of the more common side effects.

"It's not common right now for patients to take that much of a role in their own healthcare," according to Gurwitz.
It is a good idea for older patients to bring an up-to-date list of medications with them to the doctor's office, but it's an even better one to bring all their medications with them so their doctor will know exactly what they are taking.
Elderly patients often see several different doctors, each with the ability to prescribe medications, Gurwitz said.
"There is plenty of opportunity for error," he added.

As for problems with prescribing and monitoring medications, Gurwitz said that computerized physician prescribing can help to identify potential problems, including drug interactions and allergies. But these systems are only in place in about 5% of US hospitals and in even fewer outpatient offices, he said.
"There needs to be an understanding that the money invested in them is worth it," Gurwitz said.
One of Gurwitz's co-authors has served as a consultant for companies involved in preventing adverse drug events or dispensing medications.

Combined with the results of other studies, the findings show that medications "pose a significant risk to patients," according to Dr. David Classen, of the University of Utah in Salt Lake City.

"It is time to move beyond the illusion of medication safety to face the difficult reality of acknowledging the significant risk that medications pose to patients and implementing strategies to reduce it," he writes in a related editorial.

Classen worked for First Consulting Group, a company that consults on healthcare information technology, and has served as a consultant to the medical software company Theradoc. He has unexercised stock options in both these companies. He also served on the advisory board for General Electric Medical Systems.

Journal of the American Medical Association 2003;289:1107-1116,1154-1156.
Last Updated: 2003-03-04 16:42:06 -0400 (Reuters Health)


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