Drugs & Polypharmacy

It is no secret that taking care of the elderly in a nursing home is an incredibly important role that carries with it responsibilities of magnanimous proportions. In addition to offering physical aid to avoid falls and encourage mobility through physical exercises, nurses must also build rapport with their residents so that they may offer them emotional support through their caretaking process. However, the daily routine of caring for several residents often becomes exhausting for these nurses, leaving them burned out. Such exhaustion often results in a nurse leaving the facility and the relationships he or she has built with the residents. This common phenomenon among nursing home caretakers causes either a high turnover rate amongst nurses, or leaves the facility constantly understaffed.

A recent study published by The Gerontological Society of America explores the relationship that exists between nurse turnover and nursing home resident re-hospitalization. They find that many hospital readmissions may be prevented if the quality of nursing home care is improved through the hiring of more licensed nurses and licensed practical nurses. As it stands, they estimate that about 28% to a staggering 40% of re-hospitalizations may be avoided. In order to improve the quality of care, nursing homes must hire enough licensed nurses and keep them for long periods of time so that the care may be consistent. The study found that higher licensed nurse staffing correlated with lower licensed nurse turnover rates. More importantly this showed that increasing a nurse retention rate by 10% would reduce hospital readmission rates by 19%. This occurs because a long term stay at a nursing position fosters specialized knowledge which better equips nurses to provide a higher quality of care for residents.

In order to promote higher nurse retention rates in nursing homes, these facilities must invest time in constructing strategies to encourage long-term job retention. A nursing home’s priority must be to provide the highest quality of care to their residents. This includes ensuring that their residents’ needs to be hospitalized are minimized by maximizing the assistance they receive from professional nurses at the facility. In addition to the benefits conceded to residents from increasing nurse retention, there is also an economic incentive derived from it. Many nursing home administrators mistakenly believe that staff turnover is a money-saving strategy. However, nursing homes with higher performance levels on staff turnover, retention, and avoidable hospitalizations receive extra money from the CMS Nursing Home Value-Based Purchasing. Additionally, those that have an increased rate of Medicare hospital readmissions are actually sanctioned by receiving lower Medicare payments.

A recent study in the Journal of American Medical Directors Association has proposed that the use of multiple medications on patients, sometimes for off-label purposes, is a significant practice in nursing homes and may lead to adverse drug effects such as falls and delirium. This practice is referred to as polypharmacy and is reportedly widespread in nursing homes across America, with as much as 40.3 % of residents being given inappropriate prescriptions.

The overuse of these medications is particularly prevalent among psychotropic drugs such as antidepressants and antipsychotics. According to the study, between 50 and 80 percent of nursing home residents are prescribed at least one psychotropic drug. The use of antidepressants has increased among older residents as well, with a reported 49% of US nursing home residents being administered these drugs. Antidepressants are known to cause a multitude of adverse affects such as serotonin syndrome, falls, hypnatremia, delirium, gastrointestinal bleeding, and osteoporosis.

Despite growing evidence of morbidity and mortality, antipsychotic drugs have become the dominant medication in treatments of behavioral and psychological symptoms of dementia. Recent surveys have found that 1 in 3 nursing home residents are treated with antipsychotics, even though the efficiency of antipsychotic drugs is limited, with estimates between only one in three to one in five patients demonstrating significant improvement. Furthermore, the use of antipsychotic medication has been known to trigger numerous side effects such as delirium and unhealthy weight gain. Chronic understaffing in nursing homes coupled with the extensive use of antipsychotic medication for off label purposes can lead to the chemical restraint of patients. This morally reprehensible activity is a violation of the Patients’ Rights.

A study from the US national home survey also reported that 53.8% of all nursing home residents had hyper tension as a primary admission or as a current diagnosis. Of these residents, 84% were receiving at least one prescription for the complication, while 51.5% of those residents diagnosed with the condition were receiving two or more antihypertensive medications. Furthermore, there have been few trials that have included NH residents and even less that have proven a significant benefit to those residents.

The improvement in efficiency and safety of drug utilization in nursing homes has been increasingly seen as an essential element of high quality care in NH’s. This care can improve function and decrease mortality in seniors. Management of the prescription, purchase, storage, distribution, and administration of medications is an important factor in improving the health and lives of NH residents.

Articles Posted in Drugs & Polypharmacy

Re-hospitalization of Nursing Home Residents Related to Licensed Nurse Retention

Polypharmacy is Linked to Increases of Adverse Effects in Nursing Homes