Discrepancies in medication dispensation is a problem that can lead to severe issues and even fatalities. Solutions have to be found and this issue is especially prevalent with the elderly.
One possible solution that has been proposed is systematic education and reminders. This is because they can decrease the amount of prescriptions required in emergency departments that are often not appropriate for more senior patients. One such program that has implemented this are four departments from the Veterans Affairs section. By using the program, Melissa Stevens noted, they encountered “significant reductions in potentially inappropriate medications.” (Stevens, MD is from Emory University School of Medicine, Atlanta).
Another problem – particularly with this demographic – is the fact that so many people get new drugs when they are discharged from the emergency department. This figure is actually 60% with this demographic. And the drugs given are not always the right ones. Again, this has proven to be really bad by the fact that one study found that more than one in 10 elderly individuals discharged from the Veterans Affairs Medical Center in Durham, North Carolina, received a medical prescription that actually should be avoided in the elderly, which resulted in the encountering of adverse side effects.
One possible solution to this was put forward by Stevens and her colleagues. They have developed a program known as EQUiPPED, which stands for Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department in various Veterans Affairs Emergency Departments throughout the nation. She presented the findings at the event.
Over in the UK, another method is being employed to address the issue. A pilot project was conducted by Birmingham South Central Clinical Commissioning Group (CCG) and the NHS Midlands and Lancashire Commissioning Support Unit. General Practitioners were offered support through a pharmacy technician and a pharmacist. Any GPS conducting post-discharge medication reviews for patients 75+, were offered this assistance. Thirty GP practices participated in the pilot project. Patients were referred via a secure email from the National Health Service by a designated member of the practice administration team. This would not impact the patient being able to get their standard post-discharge review with their doctor. Any interventions that occurred were documented in the patient’s electronic notes.
The next step was the clinical pharmacist medication review which comprised: a review of the patient’s medical notes; a monitoring of applicable clinical investigations; an analysis of the prescription for interactions and polypharmacy matters. Thereafter, in cases where the need arose, patients were given consultations via home, phone, or surgery. Over a period of eight months, this pilot program involved 467 patient reviews, resulting in 521 interventions such as: compliance, drug formulation, drug reaction and preadmissions medicines.
The study found a substantial amount of time is being spent by GPs just to resolve medicine-related queries. With a pharmacy team, these issues were resolved by referring the patients to the project through a liaison with community pharmacists, hospital pharmacists, hospital consultants, junior doctors, community nurses and care homes.
