Medication Management Essay Paper

Medication Management Essay Paper

Tips for Effective Medication Management

So, what can be done to help older adults take medications safely? Take care to avoid some of the more common medication mistakes, such as taking drugs incorrectly or taking more than is prescribed. Pill dispensers, organizers and even reminder services can also be useful tools for some.Medication Management Essay Paper

That being said, nothing substitutes for responsible caregiver advocacy and being proactive about the drugs we and our loved ones are taking.

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Here are some other tips to keep in mind:

1. Ask your provider if the dosage is age-appropriate.

Because of the way our bodies metabolize various drugs as we get older, seniors can be more sensitive to some drugs and less sensitive to others. They are also more likely to experience adverse effects. Double-check with your doctor or pharmacist to ensure that the dosage on the prescription is age-appropriate, and ask if it’s advisable to start with a lower dose and taper upwards.

2. Be aware of medications deemed unsafe for seniors.

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, put together by the American Geriatric Society, is a list of medications that older adults should avoid or use with caution. Some pose a higher risk of side effects or interactions, while others are simply less effective.  For instance, commonly prescribed sedatives in the benzodiazepine category, like diazepam (Valium), are on the “avoid for certain conditions” list because older adults may be more sensitive to these drugs. Ask your pharmacist if any of your loved one’s medications are on the caution list, and whether you should be concerned.Medication Management Essay Paper

3. Bring a medications list — or the medications themselves — to the doctor with you.

Take your list of prescription medications —  a list of over-the-counter drugs and any herbal supplements you might be taking — and bring it to the doctor’s office with you, or to a pharmacist. The more information your provider has, the more accurately they can pinpoint any potential adverse effects or drug interactions.

4. Check on prescribe r behavior in Prescribe r Checkup.

Rather alarmingly, Medicare may not monitor prescription safety as effectively or as closely as we might like, as noted in a ProPublica report. “In 2010 alone, health-care professionals wrote more than 500,000 prescriptions for the drug [carisoprodol] to patients 65 and older,” says the report — a drug that was pulled from the European market in 2007 and is on the Beers caution list. If you have concerns about a provider, or if you simply want more information about the drugs prescribed in your area, check ProPublica’s online Prescribe r Checkup tool.

5. Closely monitor medication compliance in the cognitively impaired.

If your loved one shows signs of confusion about their medications, or has been diagnosed with cognitive impairment, Alzheimer’s disease, or another form of dementia,  do not allow them to manage or take their own medications. If they are simply having trouble tracking their medications, a reminder system may be helpful, but the situation is more serious if your loved one is cognitively impaired. Taking medications incorrectly can be harmful or fatal.

6. Create and maintain an up-to-date medication list.

American Nurse Today says, “keep an accurate list of all medications, including generic and brand names, dosages, dosing frequency and reason for taking the drug.” This can help reduce the risk of poly pharmacy.Medication Management Essay Paper

7. Get a second opinion if you are uncertain.

Not all providers are alike, and there are, unfortunately, some doctors who prescribe medications inappropriately, in excess, or for unapproved uses. If you are concerned about a prescription or a diagnosis, don’t be afraid to seek out a second opinion.

8. Know the side effect profile of your medications.

Knowing the potential side effects and interactions can help you stay alert to any health changes that may occur in response to a new medication or combination of medications. If you do notice health changes, contact a physician right away. Some side effects can mimic other health conditions, including dementia, so make sure to bring a list of your medications to every doctor visit. This will help the provider properly diagnose the problem — and help the patient avoid unnecessary or dangerous medications.

9. Make sure the pharmacy label says why you are taking the prescription.

This is particularly important for older adults who are taking multiple medications, to ensure that they know what each medication is for and how to take it properly. It can also help caregivers police whether their loved one is being given too many medications to treat the same issue, or whether a less scrupulous provider has prescribed a drug for a purpose it wasn’t intended to treat.

10. Minimize the number of providers and pharmacists you use.

Keeping the number of doctors and pharmacies to a minimum is better for you and better for the providers who must coordinate care. “The primary-care provider and specialists must maintain good communication with each other to prevent or minimize problems,” says American Nurse Today. They also advise people to “use only one pharmacy to obtain medications; this adds another level of review to help ensure appropriate dosage and reduce the risk of adverse drugs effects and interactions.”Medication Management Essay Paper

11. Talk to the pharmacist and ask questions.

If you have any concerns at all about the combination of medications you or your loved one is taking, or how a new medication will affect you, ask your doctor or pharmacist. Learn about the potential dosage, proper storage, side effects and anything else that will help you take medications correctly. You should also talk to your provider if you are thinking of stopping a medication.

12. Tell your provider about any previous adverse drug effects.

This one might go without saying, but if you or your loved one has had a bad reaction to any medication in the past, let your doctor and pharmacist know.

Medication management processes

Health service organizations procure medicines for safety. Clinicians are supported to supply, store, compound, manufacture, prescribe, dispense, administer, monitor and safely dispose of medicines.

Many of the risks associated with each part of the medication management pathway can be avoided by using systems and processes that are designed to improve safety and are based on evidence from initiatives that have demonstrated significant benefit. These initiatives focus on addressing the common contributing factors to medication errors, which include1:Medication Management Essay Paper

  • Lack of knowledge of the medicine
  • Lack of information about the patient
  • Slips and memory lapses
  • Transcription errors
  • Failure in communication
  • Lack of patient education
  • Poor medicines distribution practices.

Medication safety initiatives should focus on systems and standardization to reduce unnecessary variation, coupled with judicious use of tools and resources that improve knowledge and skills.

The actions and strategies described in this criterion aim to achieve safe and effective medicines use through:

  • Best use of information and decision support tools in clinical decision-making
  • Compliance and safety in medicines distribution and storage systems
  • Targeting known risk areas (for example, high-risk medicines), and embedding processes, practices and tools within the organization to prevent error
  • Integration of work practices that underpin safe medication management (such as standardization, monitoring and risk assessment)
  • Using medication safety strategies and tools to create an environment for the best communication of medicine-related information (for example, using an MMP).Medication Management Essay Paper

Actions within this criterion require health service organizations to:

  • Make a variety of up-to-date and evidence-based medicine-related information and decision support tools available to clinicians
  • Ensure the effectiveness of the supply chain in the safe delivery of medicines
  • Ensure compliance with relevant requirements for maintaining the integrity of medicines, minimizing wastage and disposing of medicines appropriately
  • Implement strategies for safe and secure storage and selection of medicines, including high-risk medicines.Medication Management Essay Paper

One of the reasons for end user avoidance or rejection to use health information systems is poor alignment of the system with healthcare workflow, likely causing by system designer's lack of thorough understanding about healthcare process. Therefore, understanding the healthcare workflow is the essential first step for the design of optimal technologies that will enable care staff to complete the intended tasks faster and better. The often use of multiple or "high risk" medicines by older people in nursing homes has the potential to increase medication error rate. To facilitate the design of information systems with most potential to improve patient safety, this study aims to understand medication management process in nursing homes using business process modeling method. The paper presents study design and preliminary findings from interviewing two registered nurses, who were team leaders in two nursing homes. Although there were subtle differences in medication management between the two homes, major medication management activities were similar. Further field observation will be conducted. Based on the data collected from observations, an as-is process model for medication management will be developed.Medication Management Essay Paper

Medication errors are an all-too-common problem in the U.S. In fact, they affect nearly 5 percent of the nation's hospitalized patients, according to the Agency for Healthcare Research and Quality. In addition to being detrimental to patient care, medication errors also pose a significant financial risk to hospital's bottom lines — the Network for Excellence in Health Innovation estimates preventable inpatient medication errors can cost roughly $16.4 billion annually.

Adverse drug events can also lead to readmission's. For instance, roughly 19 percent of discharged patients experience an adverse event post-discharge, and two-thirds of those events are attributable to medications, according to a study in the Annals of Internal Medicine conducted in the early 2000s. Those adverse events can increase the risk of readmission's, which can have a negative impact on patient outcomes and hospital finances.

This content is sponsored by TRC

Medication management and education are crucial for preventing adverse events and readmission's. Such initiatives can also affect patient experience scores given that three questions on the HCAHPS survey are related to communication about medication information.

Medication management influences patient outcomes, patient experience and cost. Medication management sits on a unique intersection of metrics that affect patient care and reimbursement in the value-based payment world. As such, it has received more attention in recent years from hospital leaders looking to improve three key areas at once.

Challenges Associated with Effective Medication Management

Proper medication management has become difficult for providers, according to Katherine Kenny, DNP, RN, associate dean of academic affairs at Arizona State University's College of Nursing & Health Innovation and director of research and professional practice at Dignity Health's Chandler Regional Medical Center.

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"Today, one of the biggest issues is knowing the names and classes of medications," Dr. Kenny says. Several formulations of the same medication are available on the market under different trade names, complicating medication management for nurses and other clinicians.Medication Management Essay Paper

Medication reconciliation involves reviewing a patient's complete medication regimen to ensure no drugs are duplicates or unnecessary, and the process has become more important of late.

"Critical thinking with medication reconciliation is one of the key processes that nurses perform upon admission to the hospital and upon discharge," Dr. Kenny says.

Patients are coming into the hospital with an increasing number of chronic illnesses that require more medications. In addition to critical thinking, seamless coordination of care is also imperative for effective medication reconciliation. Sometimes, there are duplicates of medication classes or medications that shouldn't be taken together — however, in the case of soiled care, it's possible that multiple providers may not notice risky drug combinations until the patient is admitted to a hospital.

Several players are involved in the sport of medication management: the physician, nurse practitioner or physician assistant who prescribes the drug, the pharmacist, and the patient.

But perhaps the person in the hospital with the most integral, influential role in the process is the front-line nurse.

"The nurse is truly the last person at the end point of the trail before medication gets to the patient," Dr. Kenny explains. "It's a major role; no one else in the hospital has that responsibility…they are uniquely situated to make an error but also to prevent an error."

How to Support Nurses and Optimize Medication Management

Supporting hospital front-line nurses with new medication learning tools can be an effective way to prevent errors, improve medication management and thereby bolster patient care and patient experience scores. Certain tools help nurses stay up-to-date and sharp on new medications, all of which drives increased confidence among nurses as they interact with patients.

Hospitals that make these types of resources available, and make them part of the core lifelong learning process for the nursing team, are in a good position to prepare their staff to do a better job with medication management overall.Medication Management Essay Paper

TRC, a medication learning company, now offers Nurse's Letter, an online medication learning tool that aims to "help improve care, outcomes and medication learning through concise, trusted, evidence-based recommendations and education," says Sherri Boehringer, PharmD, vice president and senior editor of TRC.

Each monthly edition of Nurse's Letter features at least 10 short articles which provide advice on new medications, important trial results, proper medication administration, medication safety and strategies to increase medication adherence. The monthly content also contains drug therapy comparison charts and patient handouts in English and Spanish to help patients stick with their medication regimens.

The whole publication is written by pharmacists, vetted by nurses and is free from pharmaceutical influence and any advertising.

How it's Done

It starts with the writing core. Experienced pharmacists, some of whom still practice, write the content and edit the monthly Nurse's Letter. These pharmacists all have doctoral degrees and 10 years of hospital experience on average. The lead editor pharmacist has more than 20 years of experience.

With an experienced team in place, TRC then relies on a rigorous, evidence-based, multi-step editorial process.Medication Management Essay Paper

To make sure Nurse's Letter covers topics important to nurses, TRC determines the "big questions" every month. These big questions are pivotal to TRC's editorial process and are one differentiator from current nurse resources. It's through the big questions that editors succinctly answer the common questions healthcare providers not only encounter, but need to know in their daily practice.

To identify these big questions that nurses both need and want to know, the TRC staff scours journals, blogs and government statements and also monitors the lay press. Subscribers also write or call with medication therapy questions, according to Dr. Boehringer.

These efforts result in TRC's editors accumulating more than 1,500 big questions each month.

To narrow these big questions down to the most critical, TRC hosts a monthly webinar with its editors as well as healthcare providers from various disciplines to identify the most relevant, practical and timely topics.

Then, editors research the topics that have resulted from the big questions and build evidence-based recommendations around them. They do this by evaluating significant research from journals and communicating directly with national guideline authors, specialists and government agencies like the Drug Enforcement Agency and the Food and Drug Administration. Finally, they draft the content and distill it down to just the most pertinent points. Each article — which can be read in five minutes or less and average less than 30 lines of text — features five or six medication therapy recommendations and suggested resources to find more information.Medication Management Essay Paper

Additionally, each recommendation is vetted through a six-step review process by specialists and front-line clinicians.

"We refine each sentence and word to make sure it's as clear as can be, 100 percent evidence-based and practical," says Dr. Boehringer.

Benefits in Today's Environment

Studies have linked the introduction of educational medication tools in healthcare organizations to decreased hospitalization rates and readmission's. An ACO in Kentucky and Indiana with 50 physicians and 12,000 Medicare patients implemented TRC's Prescribes Letter — a tool similar to Nurse's Letter but aimed at prescribe rs — and saw a 26 percent decrease in patient hospitalization across all disease states, a 24 percent relative drop in discharges and a 7 percent drop in 30-day hospital readmission's after a seven-month period.

Based on these results, it stands to reason that equipping nurses specifically with an electronic medication learning resource with unbiased, succinct, well-researched content may have many positive outcomes for the hospital and the nurses themselves in today's healthcare environment.

There is a growing number of retiring nurses in the U.S., especially among baby boomer nurses who are leaving the profession at increasing rates. One 2016 survey from AMN Healthcare showed 62 percent of registered nurses over age 54 are considering retiring in the next three years. Hospitals are hiring younger nurses to fill the vacancies left by retiring nurses; however, those younger nurses have less experience than their older coworkers when it comes to earning practical experience in medication management.Medication Management Essay Paper

"I think there is a gap between what nurses learn about pharmacology and theory in school and being able to apply it in a real situation," Dr. Kenny says. An electronic resource can especially "help young nurses in transition," she adds.

However, nurses of all ages can benefit from a current, unbiased medication learning resource like Nurse's Letter, as new medications are continually released. "I think nurses like reading it because we tackle the problems they encounter in day-to-day practice in a manner that's easy to digest," says Dr. Boehringer.

It can also serve to elevate the nursing profession as a whole, according to Dr. Kenny.

"This is a source truly dedicated to the professional practice of nursing," she explains. "So many items in a hospital are there for the infection control team, or the quality measures team, or physicians. Nurse's Letter is unique to nurses… Having a resource dedicated to nurses really elevates the presence of nursing."

Tools such as the Nurse's Letter empower nurses to provide the best care possible and elevate their presence in the hospital. These resources also have far-reaching implications for hospital's bottom line in value-based care models, since medication management can positively affect so many metrics, like readmission rates, medication errors and medication-related adverse events and patient experience scores.Medication Management Essay Paper

Medication Management

The management of medicines is a problem. It is estimated that more than half of people with a chronic condition fail to take their medicines as prescribed. This has flow on effects of increased risk of adverse drug reactions, exacerbation's of underlying conditions and costs.

Nurses are available to patients in a number of means providing an opportunity to identify and discuss medication management problems. This may be in relation to administering medication as prescribed, supporting others in this role, or in providing feedback to the prescribe r. Patients and families will also require advice and support on the medications that they are taking and nurses will often fulfill this role.

Statistics on medication errors in U.S. hospitals are difficult to calculate, due to the variability in reporting. In 1999, the government released a report titled To Err is Human: Building a Safer Healthcare System, which stated that approximately 98,000 people die each year in the United States due to medical errors (Institute of Medicine [IOM], 1999). Based on the IOM report, it is now estimated that as many as 440,000 deaths occur each year due to medical errors (James, 2013). Studies estimate that approximately 19.1% of these errors are medication administration errors (Keers, Williams, Cooke, & Ashcroft, 2013).

A cross-sectional study was done with 203 nurses to examine medication knowledge and the risk of medical errors. Participants were from acute care hospitals and primary care settings. As part of the study, each participant was given a test on pharmacology, drug management and drug calculations. The study showed that the participants had a 39% moderate risk and 11% high risk for pharmacology knowledge, 33% moderate risk and 26% high risk with drug management, and 32% moderate risk and 7% high risk with drug calculations (Simonsen, Johansson, Daehlin, Osvik, & Farup, 2011).Medication Management Essay Paper

As nurses, we are often the last “gatekeeper” in the administration process to prevent medication errors. It is important to take the time needed to ensure patient safety, and to minimize distractions throughout the process. Here are strategies on how to prevent medication errors in nursing:

• The rights of medication administration. Initially, there were five rights for administration including the right patient, drug, time, dose and route. A sixth right is the right reason. Some literature describes up to 12 rights, including education, documentation, right to refusal and expiration date.Medication Management Essay Paper

• Independent double checks. The Institute for Safe Medication Practices (ISMP) (2014) recommends the use of redundancies, such as independent double checks of high alert medications due to the increased risk for patient harm. This includes independent calculations for dose and rates of medication. The list of high alert medications can be found at http://www.ismp.org/tools/institutionalhighAlert.asp

• Medication review. Practices include comparing the medication administration record and patient record at the beginning of a nurse’s shift; determining the rationale for each ordered medication, and requesting that physicians rewrite orders when improper abbreviations are used, are important strategies.

• Knowledge. A nurse should never administer a medication which he/she is unfamiliar.

• Patient education. Ensuring that patients and families are knowledgeable regarding the medication regimen so that they can question unexplained variances are also associated with lower rates of medication errors.Medication Management Essay Paper

• Practice environment. A supportive practice environment, including teamwork between physicians and nurses; opportunities for nurses to participate in hospital- and unit-level decisions; continuity of patient care assignments; continuing education opportunities; and the retention of nurse administrators who are visible and accessible, who listen to nurses concerns, and who have high expectations of their nurses are associated with a higher quality of nursing care. (James, 2013; RWJF, 2012; Simonsen et al., 2011)

Medication management for older adults

As we age, our bodies change. Some changes we can see and feel: aches and pains may linger and simple movements like walking or getting out of a chair may be slower or more painful than they used to be. Some we can’t, like how our bodies may change in how they respond to and absorb medicines. For example, according to the U.S. Food and Drug Administration and its medication guide for seniors, changes in the digestive system can affect how fast medicines enter the bloodstream.

ORDER A PLAGIARISM-FREE PAPER HEREChanges in body weight can influence the amount of medicine you need to take and how long it stays in your body. The circulation system may slow down, which can affect how fast drugs get to the liver and kidneys. The liver and kidneys also may work more slowly affecting the way a drug breaks down and is removed from the body. This means medicines may stay in the body longer and cause more severe side effects if doses are not properly adjusted and monitored. Because of these and other changes in our body as we age, there is also a higher risk of drug interactions in older adults.Medication Management Essay Paper

Medication Management For Seniors

One daily challenge that many caregivers face daily is medication management for seniors.  Medication Management for seniors falls to the caregiver for a variety of reasons:

  • The patient cannot physically open the containers that hold the meds.  In these circumstances, the caregiver needs to set out the meds for the patient to take at the appointed time;
  • There are more meds than the patient is capable of tracking, or the administering of them requires some help;
  • The most common issue is confusion or cognitive impairment, and this usually occurs when the patient is suffering from dementia or a variety of conditions, each of which requires separate medication.Medication Management Essay Paper
Medication Management Tools For Caregivers

Here are some choices available to caregivers.  Check with your local pharmacy to find them.  They may also be available through your local senior center or senior resource office:

  • Pill boxes labeled by the day of the week.  They do need to be filled accurately at the beginning of the week, but after that, the pills are easy to find and take.
  • Blister Packs (also known as Bubble Pack) are a fairly new way of packaging medications for consumers, although elder care communities and hospitals have been using this method for some time.  The Packs are prepared by the pharmacy and each pack contains one day worth of pills, or pills to be taken at a certain time, such as breakfast or dinner.
  • Some Pill boxes come with alarms for people who need prompting and reminding to take their medications.  Some also come with a monitoring service that can alert the caregiver when medications have not been removed from the box.

In addition, there are visiting medication management services which can provide an aide or nurse to visit the patient’s home to assist with medications.  Some In-Home Care agencies will offer medication management as part of their services.  Check with your local Area Agency on Aging to find out what’s available in your area.Medication Management Essay Paper

Managing mental health medications

It is important to remember that medications do not cure mental health conditions. They can make your symptoms of mental illness go away or affect you less, but if you stop taking them, your symptoms may come back. If something about your mental health medication bothers you, it is important that you talk with your doctor or counselor about it before you stop taking any medication as suddenly stopping the taking of medications can cause unwanted side effects.

Types of mental health medication

There are six main types of mental health medications:

  • antidepressants – used to treat depression, anxiety and some types of personality disorders
  • anti psychotics – used to treat schizophrenia and sometimes bipolar disorder and to help restore your brain's chemical balance
  • mood stabilizers – often used to treat people with bipolar disorder Medication Management Essay Paper
  • depressants – used to help people become or stay calm.
  • anxiolytics – often used to treat anxiety disorders
  • stimulants – used to treat attention deficit hyperactivity disorder (ADHD)
How long will it take for mental health medications to work

Stimulants and analytics start working quickly — within a few hours or even less. They stay in your body for a relatively short time.

Antidepressant medications usually take around two weeks for you to feel the benefits. Ask your doctor or pharmacist for further information or view the drug information sheets now available online for further details. The effects of drugs can vary for different people depending on their body size and metabolism. Your doctor will want to see you two or three weeks after you start taking them to check that they are having an impact on your illness.

Anti psychotics take between six weeks and up to a few months for their full effects to work. If you are prescribed anti psychotics, your doctor will want to see you regularly to check how you are going.

It is important to be honest and open with your doctor about how you have felt since starting medication. You might feel shy or embarrassed to tell them personal things to do with your emotions and your body, but they have been trained to deal with sensitive issues. See the page ‘Talking to your doctor about sensitive issues for advice on how to be open and honest with your doctor.Medication Management Essay Paper

Side effects and long‑term impacts of mental health medications

Most mental health or psychiatric medications have side effects. The most common ones are:

  • headaches
  • weight gain
  • dizziness
  • dry mouth
  • muscle spasms and cramps
  • nausea
  • loss of sex drive
  • constipation
  • sleepiness or problems sleeping.

Tell your doctor if you have any of these symptoms or any others that you did not have before taking the medication.

Some drugs can have other effects if you take them for a long time. Anxiolytics like Valium are addictive and if used for too long can do things like:

  • make you depressed or paranoid
  • change your personality
  • give you headaches and nausea
  • make you gain weight
  • damage your memory.Medication Management Essay Paper
How medications mix with other things in your body

The chemicals in your medications can interact with chemicals in other things you are taking — even if it is just paracetamol for a headache or vitamin tablets. Because of this, it is really important to tell your doctor everything that you are taking.

Make sure you tell them about any other medicines, vitamins or herbal supplements you take, as well as what you have been eating and drinking, especially alcohol.

Medication in hospital and at home

When you are admitted to hospital, it is usually because you are seriously ill and need extra treatment to get well. While you are in hospital, you are usually given different types and doses of medication to what you might have been taking or will be prescribed once you are well enough to go home. You also have people giving you your medications when you need them. Once you are home you need to manage your medication use.Medication Management Essay Paper

Once you are home, it is really easy to forget to take the right medications and dosage at the right time, and you might not have people with you all the time to remind you. Some things you can do to help remember to take your medication at the right time and right dosage include:

  • make a schedule of the week with names of drugs, the dose, and what day and time each should be taken, and put it on the fridge
  • put your tablets into pill boxes with labels for the time of day and day of the week they can be taken
  • put reminders or appointments into your phone for when you need to take each drug.

Keep regular appointments with your doctor or counselor so that you can all keep track of how you are going and how your medications are working for you.Medication Management Essay Paper

Paying for medication

Australia’s Pharmaceutical Benefits Scheme (PBS) is the government program that provides affordable medications to all those covered by Medicare. Understanding Medicare the scheme subsidizes a wide range of approved prescription medications, including those used to treat mental illness.

Australian citizens, New Zealand citizens living in Australia and most permanent residents of Australia are covered by Medicare and the PBS. If you are not sure if you are eligible, visit or call a Medicare office to find out if you are covered.

If you are visiting from overseas, you might be covered by one of Australia’s Reciprocal Health Care Agreements. Each country has a different arrangement with the Australian government, so it is important to find out what you are covered for and what the conditions are.

Australian citizens may be eligible for a concession card from the Department of Human Services, which can give you a discount on medication.

Medications Play a Key Role in Treatment

Prescribed medications play a key role in the treatment of co-occurring disorders. They can reduce symptoms and prevent relapses of a psychiatric disorder. Medications can also help patients minimize cravings and maintain abstinence from addictive substances.Medication Management Essay Paper

In order to get the most out of medication, patients must make an informed choice about taking medications, and understand the potential benefits and costs associated with medication use. In addition, they must take the medication as prescribed by a mental health professional.

Taking medication is not substance abuse. Some people in recovery for a substance use disorder may think it is wrong to take any medications. However, a medication that manages one's mood is very different from a drug that alters one's mood.

Effective medication

Prescription medications have been developed and tested for all of the Axis I psychiatric disorders. Effective medication options exist for the treatment of most of the major disorders, including mood disorders such as major depression and bipolar disorder; anxiety disorders, such as post-traumatic stress disorder, panic disorder, social anxiety disorder, and generalized anxiety disorder; and schizophrenia and other psychotic disorders.

Placebo-controlled trials have demonstrated that medications for mental health disorders reduce or eliminate symptoms. For example, antidepressant medications such as the selective serotonin re uptake inhibitors (SSRIs) consistently reduce symptoms of depression by 30 percent to 60 percent overall and lead to complete remission in a significant proportion of patients. Effective psychotherapies have also been developed and tested for many mental health disorders and can be utilized without medications for patients with mild or moderate disorders. However, medication is an important mainstay of treatment for patients with more severe and/or long-standing mental illness symptoms.Medication Management Essay Paper

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Medication adherence

Many patients do not take medication as prescribed. Some simply forget medications, but often "forgetting" is really related to an underlying concern. Prescribe rs should assume that a patient will sometimes fail t to take his or her medications. In these cases, they should ask about the missed medication in a nonjudgmental way. When patients are not adherent to the medication plan, modifications to the medication prescription or to the plan should be based on the patient's unique reasons for not taking them.

Non adherence to the medication plan is often found in a patient who experiences the following:

  • medication-relented side effects
  • concern about the interactions between substances and the medication (a patient may not take his or her medication if a return to substance use occurs)
  • belief that the medication isn't working
  • feeling better, which leads the patient to believe that the medication is no longer needed
  • attribution of the mental health disorder symptoms to the use of the medication
  • disorganization or apathy related to the ongoing substance use disorder or mental health disorder
  • lack of family support for medication taking Medication Management Essay Paper

Addressing side effects

If a patient reports side effects, or changes the way he or she takes medications due to side effects, prescribe-rs should do their best to address the problem. Full empathic attention to the difficulty and reassurance that it will subside is sometimes enough to reduce the concern. Serious side effects or ones that interfere with functioning should be addressed by changing the timing or dose of the medication, by taking the medication with or without food, or by using another medication to alleviate the problem. At times, a medication switch will be required to address non adherence.

Medication use and the active use of substances

Prescribes should avoid prescribing medications that are known to interact with the patient’s preferred substances of abuse. Psychotropic medications that are safe in the context of substance use should be utilized with the following advise:

“Please take this medication every day, even if you are using substances. The medication won’t help your problem with depression if you don’t take it every day, even after you are feeling better. As we have discussed, your goal is to avoid using substances, but if you do use, take the medication anyway.”Medication Management Essay Paper

Admonitions to the patient not to use substances because he or she is on a medication often result in the patient using substances and not taking the medication.

Medication use and mental health disorder symptoms

Some patients may attributed mental health disorder symptoms to medication use. A careful documentation of mental health disorder symptoms prior to prescribing medication is helpful in this situation. Patients with psychosis, for example, may say the medication causes hallucinations. Patients with depression and fatigue may attribute the fatigue to the medication. Education and reminders can be helpful, but if a patient is fully convinced that the medication is causing mental health disorder symptoms, switching medications may be an option to address this problem.

Medication use and family support

Sometimes a patient is willing to take medication as prescribed, but the attitude of a family member interferes. Inquiring about how family and friends perceive the use of medication is important. If a spouse has concerns, it’s vital to include him or her in the educational process. It's important for clinicians to provide education to all concerned family members. This education should include information about mental health and substance use disorders and their treatment. (Read more about family support.)

Medication use and peer support groups

While the official stance of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) is that taking medications prescribed by a medical professional is compatible with recovery, some individuals in peer support groups may still view psychotropic medications as potentially addictive substances that should be avoided by people with addiction or substance use issues. This perception may be due to the fact that benzodiazepines and other tranquilizers, which can indeed be addictive, were commonly prescribed in the past to patients with substance use disorders. Many effective, nonaddictive alternatives to these medications are now available.Medication Management Essay Paper

Patients may run into particular individuals in peer support groups, or even entire groups, who are not supportive of medication use. It’s important to remind people that medication is one important tool they can use in their own personal recovery path. The patient may want to shop around for other peer support groups that are more supportive of people with co-occurring disorders.

Medication tapering and discontinuation

The effects of medication for mental health disorders can take several days to several weeks to take place, and it can take several months for their full effects to be felt by a patient. Once the mental health disorder is stabilized over a period of months, the medication should be continued for approximately six months. Patients with mood and anxiety disorders may consider tapering and discontinuing medication, depending on how chronic and severe the mental health disorder symptoms are. Patients with bipolar disorder and psychotic disorders may benefit from remaining on medication for a much longer period of time, often for life. Research suggests that relapse of symptoms occurs within a year of discontinuation of medication in these types of disorders.Medication Management Essay Paper

Medication Therapy Management Services

Medication Therapy Management Services Circle Diagram

Medication Therapy Reviews

The medication therapy review is a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them. Medication therapy reviews are one of the five Medication Therapy Management Core Elements Service Model Version 2.0 1   these reviews can be comprehensive or targeted to an actual or potential medication problem. Whether comprehensive or targeted, the individual patient’s medications are evaluated in the context of the patient as a whole, taking into consideration all of the patient’s conditions and medication therapies.Medication Management Essay Paper

1. American Pharmacists Association, National Association of Chain Drug Stores Foundation. J Am Pharm Assoc. 2008; 48(3):341-53

Pharmacotherapy Consults

Pharmacotherapy consults refer to services provided by pharmacists on referral from other health care providers or other pharmacists. These consult services are typically reserved for more complicated patient cases, specifically for patients who have complex medical conditions and who have either already experienced medication related problems or who are at high potential to develop them.1, 2 A pharmacotherapy consult incorporates the pharmacist’s expertise into achieving desired therapeutic goals for patients by promoting safe, appropriate, and cost-effective use of medications.  Patients requiring pharmacotherapy consults may have a single or multiple complex medical conditions that require medication therapy to effectively manage. Pharmacists providing these services typically have advanced expertise and training in the subject area and may be Board Certified in their specialty by the Board of Pharmaceutical Specialties.

1. ACCP White Paper. Pharmacotherapy 2008;28(2):7e–34e
2. Bluml BM. Definition of medication therapy management: development of profession wide consensus. J Am Pharm Assoc. 2005;45:566-72.

Disease management coach/support

Disease management principles involve coordinated healthcare interventions for diseases in which patients must assume some responsibility for their care. Pharmacists providing these medication therapy management services address drug and non-drug therapy, as well as lifestyle modifications associated with these diseases integrate the patient into programs that empower them to manage their disease and medications, and thereby reduce healthcare costs and improve quality of life of patients.  Diverse disease management programs that incorporate effective medication management have been developed for a variety of chronic disease state  such as Diabetes, Asthma, COPD, Heart Failure, Parkinson’s Disease, Alzheimer’s Disease, Depression and many others. Examples of the clinical, humanistic, and economic outcomes of these programs provided by pharmacists have been documented in demonstration projects that include the as The Asheville Project, The Diabetes Ten City Challenge, and many others.Medication Management Essay Paper

Pharmacogenomics Applications

Pharmacogenomics is a new and emerging medication therapy management service provided by pharmacists in which pharmacists play a role in the interpretation and application of a patient’s genetic information to optimize a patient’s response to medication therapy. In various patient care settings from hospitals to community pharmacies pharmacists are comparing patient-specific treatments based on genetic markers, predicting patients response to therapy, dosing medications based on  genetic test results, predicting which patients will experience adverse reaction to selected therapies, and making informed recommendations to prescribe rs on the best treatments for that individual patient that maximize effectiveness while minimizing risk.  Pharmacogenomics has also been referred to as “personalized medicine.”

Anti coagulation Management

Pharmacists providing anti coagulation management provide diverse services to patients who are taking oral blood thinning agents.  Warfarin,  the most prescribed oral medication agent for this purpose, must be continuously monitored and managed to ensure patient safety and minimize risk. Pharmacists work with educating many different types of  patients  on these therapies such as those with atrial fibrillation and at high risk for stroke on the importance of oral anti coagulation adherence and attaining routine blood tests. Pharmacists provide services in anti coagulation management.  Examples of services provided by pharmacists include in-pharmacy fingers sticks and INR testing , education on patient self monitoring/management,  and adjustment of doses based established collaborative practice agreements between physicians  and the pharmacist.

Other Clinical Services

As pharmacist provided medication therapy management services continue to evolve, pharmacists roles continues to expand into new and emerging areas. These diverse clinical services all focus on optimizing medication outcomes for the individual patient. Examples of other clinical services in medication therapy management include employee health services & screening, travel medicine, nuclear pharmacy, veterinary pharmacy, nutrition and many others.Medication Management Essay Paper

Medication Safety Surveillance

Pharmacists provide medication therapy management through medication safety surveillance programs, where they serve an important role in prevention of medication errors and adverse events. Improving the safety of the medication use system as a whole is critical to achieve optimum therapeutic outcomes for individual patients. From medication error and adverse event reporting to the collection of data and identification of medication safety on an expanded scale, pharmacists are breaking new ground in ensuring medication related safety. Emerging areas include the development, utilization and standardization of Risk Evaluation and Mitigation Strategies (REMS), a program for drugs or biologic s that pose specific safety risks for patients, will optimize the balance of patient access and medication safety.  REMS programs are being required more and more by the Food and Drug Administration to address potential patient safety issues.

Health, Wellness, public health

Pharmacists provide a wide range of health, wellness and public health services to improve care for individual patients in the communities they serve. Examples of services include screening programs for common disease states (e.ge. asthma, diabetes cardiovascular disease)  nutritional planning, weight loss, smoking cessation counseling, These services help to address the critical need to improve the overall health and wellness of the U.S. Population.Medication Management Essay Paper

Immunization

Pharmacists in all 50 states are authorized to provide medication therapy management by administering immunizations under collaborative practice agreements with physicians. Pharmacists provide valuable immunization services and information for patients to improve vaccination rates for vaccine preventable illnesses.  Pharmacists provide immunization medication management services through identification of patients based on disease states and medication therapies that could potentially benefit from receiving various vaccines and by directly immunizing those patients or providing education on the benefits and importance of vaccinations for preventable illness.  Pharmacist administration authority varies from state to state based on individual scope of practice regulation. For example, pharmacists administer seasonal flu vaccine, H1N1 vaccine, herpes zoster vaccine, travel vaccines, and many others.

The Importance of Medication Management

The main reason individuals take medication is to improve quality of life. However, if you are not feeling well or taking multiple medications, remembering to take the right medications at the right times can be difficult. If medications aren't taken properly, quality of life does not improve, and in many cases, it declines.Medication Management Essay Paper

This is where medication management comes in; it can assist in getting the right prescriptions to the right individuals, and ensure they are taken at the right time. But there’s a whole lot more to medication management…

Why Use Medication Management?

According to research, non-adherence to proper medication administration has a drastic impact on overall healthcare costs.

  • It is estimated that on average, 50% of patients in the U.S. do not take their medications correctly. Nearly 33% never fill their first prescription at all.
  • An average of 700,000 people experience adverse reactions to their medications that land them in the emergency room.
  • A whopping $290 billion is the estimated cost each year of patients failing to take their medications properly.

Expert medical personnel who help individuals manage medications contribute to an individual’s improved quality of life, as well as ensure a person's safety. Medication management services contribute to:Medication Management Essay Paper

  • Improved patient use and administration of all medications
  • Improved percentage of patients meeting their health care goals
  • Reduced side effects and duplication, as well as drug interactions, of all medications
  • Decreased medical costs in the form of fewer emergency room visits and hospitalizations due to incorrect dosing or neglecting to take prescribed medications.
What is Medication Management?

Medication management is a service designed to help individuals manage their medications so they take them on time, all the time, and avoid the dangers of incorrect medication administration. This service is often used in assisted living settings and senior living communities.

For some people, simply using an over-the-counter reminder device is sufficient in making sure they take their medications as prescribed, but for others, more advanced, consistent reminders and help is necessary. In many assisted living settings, residents receive medication management services from trained licensed and unlicensed staff to ensure all prescriptions are filled on time and all medications are taken correctly on a daily basis.

Benefits of Medication Management

As America's older population continues to grow, the need for quality medication management services does too. It is an important tool for ensuring the health of these individuals as well as managing their health care costs. Benefits of providing medication management for this population include:

  • Better outcomes for older adults.
  • Less stress for the patients and their families. Everyone can be comfortable knowing medications are being distributed and taken correctly.Medication Management Essay Paper
  • Less money spent on related health care costs such as emergency room visits and hospital stays
  • Reduced illnesses and deaths due to medication noncompliance or drug interactions

Whether someone neglects to take their medications properly because they forget or think they don't need it, the fact is, failing to do so can lead to serious consequences. Through medication management, individuals get the medications they need, on time, every single day. Their quality of life improves immensely and everyone involved is able to worry less about the health of their loved ones.

Medication management is a helpful tool used in many senior living communities to ensure individuals are able to lead a healthy, happy, full life.

In a given year, there are more than four billion prescriptions filled at pharmacies in the U.S- not including over-the-counter drugs and other medicines. With such high volume, there is a great need for medication management. Medication management is the monitoring of medications being taken by confirming directions are being following and making sure that dangerous drug interactions are avoided. This is especially important for those taking large numbers of medications to address chronic illnesses and multiple diseases, which is more prevalent among seniors. To understand why managing your medication is important, review the list below.Medication Management Essay Paper

Why Medication Management is Important
  1. A large percentage of seniors are taking prescription drugs: Approximately 70% of Americans are on at least one prescription drug with seniors making up more than 40% of those prescriptions.
  2. A large percentage of seniors are taking multiple prescription drugs: According to the American Society of Consultant Pharmacists, on average, individuals that are 65 to 69 years old take nearly 14 prescriptions per year and individuals aged 80 to 84 take an average of 18 prescriptions per year.
  3. The more prescriptions needed, the more difficult they are to keep track of: The high volume of prescription medications, as well as over-the-counter medicines used, increases the likelihood of potential mistakes. Taking the appropriate medication on time and routinely is extremely important and necessary.

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  4. Improper Medication Management can lead to adverse reactions and hospitalizations: Adverse drug reactions and noncompliance are significantly higher among older adults aged 65+, which results in frequent emergency room visits. The risk of not following the proper medication regimen after surgery or for chronic pain/illnesses, or to mix with over-the-counter medicines can result in serious complications, re-hospitalization, and a greater cost of recovery (both financial and physical).Medication Management Essay Paper
  5. Proper medication adherence and management can lead to a successful recovery of a short-term illness or control of a chronic illness.

Using Caring Village for Medication Management

There are many different types of devices and mobile apps designed to make managing your medications easier. The free Caring Village app is uniquely designed to help you keep an accurate list of current and past medications at all times. In addition, the app allows you to store photos of medications and track refills. See just how easy it can be by creating your free village today.

Always consult a physician if you are unsure of what medicines to take, if instructions are unclear, or if you are uncomfortable taking your medications.

Medicine Management
What is medicines management?

Patients depend on medicines to help maintain health, prevent illness, manage chronic conditions and treat disease. Medicines are an important part of what the NHS does to help patients and are a precious resource. Medication Management Essay Paper

Prescribing is the most common therapeutic intervention that takes place in the NHS.  The NHS spends £11 billion per year on drugs and 85% of this spend takes place in general practice.

NHS Ipswich and East Suffolk Clinical Commissioning Group (CCG) are responsible for the prescribing budgets of its member practices and employs its own medicines management team who work closely with the GP practices to support high quality cost effective prescribing.

What does the medicines management team do?

The CCG has a small Medicines Management team of pharmacists and pharmacy technicians who work closely with GPs and local health providers to help get the best out of medicines for local people.

The Medicines Management team uses its experience and knowledge of medicines to ensure that patients within Ipswich and east Suffolk get the medicines they need to effectively manage their condition.

As new medicines are developed and new research is published on existing drugs, medicines are constantly monitored and GPs and patients alerted to any changes. Medication Management Essay Paper

The Medicines Management Team supports the CCG’s aim to improve the health of the population by optimist the use of medicines through:

  • Promoting the safe, evidence based and cost-effective use of medicines
  • Providing up to date, unbiased information about medicines, treatments and care pathways
  • Supporting practitioners and patients to make best use of medicines
  • Minimizing the harm caused by medicines
  • Developing local guidelines and care pathways to optimize the management of conditions
  • Collaborating with local hospital trusts and other healthcare providers to support these aims
Clinical Oversight Group / Medicines Optimization Group

The role of the Clinical Oversight Group (COG) is to provide clinical recommendations to the Clinical Commissioning Group (CCG). Medication Management Essay Paper

The group has a range of responsibilities that includes receiving, scrutinizing and making recommendations on the traffic light status of new drugs or existing medications. The Traffic Light System (TLS) is a color-coded system that provides recommendation and restriction information on the prescribing of individual drugs in primary and secondary care.

One of the most important roles of the group is to review new drugs coming onto the market or existing drugs that have a new licensed indication, in order to make a clinical recommendation to the CCG on whether clinically the new drug should be supported.

Electronic medication management has been developed to improve patient safety by increasing the legibility of prescriptions, implementing passive and active decision support and allowing access to medical records across a wide area.1 It is a patient safety initiative, albeit some stakeholders see it as a cost-saving exercise. Electronic medication management is a broad term covering all computer systems involved. It is a closed loop system that encompasses prescribing, administration, pharmacy review, smart infusion pumps, automated dispensing cabinets, barcode medication administration and anything that has electronic medicines data sets or encompasses medication management processes.2 Medication Management Essay Paper

There are a number of electronic medication systems available. These vary from software for individual practitioners to stand-alone systems for specialties (e.g. oncology, intensive care), and hospital or district-wide systems with or without an integrated, fully electronic medical record.

Electronic prescribing keeps track of medicine use through computer applications. With district-wide systems, this record is available across all sites within the local health district for transfers or future admissions. For example, when a patient is discharged from a hospital in NSW, the discharge script is printed from the software and the discharge medication list is exported in the electronic discharge summary for transmission to GPs, NSW Health eNet and My Health Record.

An electronic prescribing system provides an easily accessible record of administration. It improves access to medication histories across the continuum of care from the GP to the hospital and back to the GP.Medication Management Essay Paper

Data and reports available in electronic prescribing systems allow audits on drug use, including tracking orders for antimicrobial stewardship, medicine recalls and analysis of usage patterns. The software can incorporate standardized prescribing protocols for specific conditions, for example pain management, vaccinations and acute coronary syndromes.

Responses to drug shortages across a health district can be coordinated with alerts and suggestions for alternatives. These can be deployed across all sites rapidly.

One of the main benefits of using an electronic prescribing system is that the software improves overall legibility. A clear, typed prescription decreases interpretive errors. The person reviewing or administering does not need to decipher illegible handwriting and error-prone abbreviations.

Electronic prescribing also reduces the risk of dosing errors as it can specify commonly used doses. Potentially dangerous doses are minimized as the software guides prescribe rs towards using the more common doses. This does not, however, prevent all of these errors as the software needs to provide flexibility during prescribing. For example, restricting oral methotrexate to a maximum of 30 mg on one day per week would prevent prescribing of the higher doses (up to 100 mg) required for medical management of ectopic pregnancy.Medication Management Essay Paper

Recording of electronic prescribing and administration also allows the standardization of orders and can provide clinical alerts. For example, if clozapine is prescribed, a message to contact the clozapine coordinator can appear along with the investigations required for safe prescribing.

Electronic prescribing can also help to prevent the prescribing of drugs to patients with medication allergies by recording allergy and adverse drug reaction information. When allergies are correctly entered into the system, the software alerts the prescribe r with details of the allergy. Unfortunately, even with prompts within the system, not all patients have their allergies recorded, some allergies are recorded incorrectly, and in larger organizations there may be multiple silos of allergy data with details recorded in other sections of the patient record that are not accessible to the electronic prescribing system.

Another issue with managing allergies is that it does not prevent clinicians from entering incorrect information (simple user error). For example, a prescribe r could enter penicillamine allergy for a substance allergy when they mean penicillin. In the electronic prescribing software, the specific substance is benzylpenicillin or phenoxymethylpenicillin and the allergy group is penicillin.Medication Management Essay Paper

With any electronic prescribing system comes an opportunity to provide knowledge-based clinical decision support at the time of prescribing or administration. However, this needs to be balanced with the risk of alert fatigue.3 The commonest source of alerts is for drug interactions. Unfortunately, in some systems the drug interactions detected can be over-inclusive, and trivial or minor potential interactions can fire the same or very similar styles of alert as potentially life-threatening ones. As a result, the flurry of much more common, unimportant alerts trains the user to ignore all alerts including the important ones.

Another frequent source of alerts is therapeutic duplication which warns if two drugs of the same class are prescribed simultaneously. Here, the usefulness of such alerts depends heavily on the definitions of the therapeutic classes.

If, for example, all corticosteroids are put into one class then an alert will fire (inappropriately) when a patient with asthma on preventative puffers is prescribed prednisolone for an acute exacerbation. Having heparins and oral anticoagulants in one therapeutic class will provide an appropriate alert when enoxaparin is inadvertently prescribed as bridging therapy for a patient starting on rivaroxaban, but an inappropriate alert if that patient was starting on warfarin. A warning regarding multiple antipsychotics may be important to a junior medical officer on a general medical ward, but to a psychiatrist in a mental health unit it may be annoying.Medication Management Essay Paper

In our own implementation of an electronic prescribing system for the Hunter New England Local Health District, the Quality Use of Medicines Committee turned off drug interaction warnings on the advice of sites already using the software. However, we have continued the alerts for therapeutic duplication. Our preliminary analysis shows that 95% of duplicate therapy warnings are not immediately actioned. However, what about the 5% that are actioned? Has this made a significant impact? 4 In a system as complex as a large heath district, it is difficult to isolate cause and effect. The Quality Use of Medicines Committee has decided to remove duplicate therapy warnings provided by the software vendor and replace them with specific tailored alerts determined by local expertise. The goal is to make every alert relevant to that prescribing or administration circumstance. As the software matures, we hope to nuance our warnings and alerts.Medication Management Essay Paper

The implementation of electronic prescribing across our district has improved patient safety, communication and accountability, and provides an electronic record of medication prescribing and administration. However, ongoing work needs to be done to address problems with alerts, developing protocols, adding new medications and overall system improvements. We need to improve usability to increase engagement while maintaining the focus on patient safety.medication Management Essay Paper