One of the most difficult aspects of self-care at home is medication management. Studies have found that as many as two-thirds of hospital visits for seniors are triggered by medication problems. The issue of polypharmacy — taking four or more medications — can increase the chance of an error. The typical Medicare patient leaving the hospital may have as many as 13 drugs prescribed by 2 or more physicians of different specialties and practices. Managing a large number of drugs to be taken at certain doses and times can be tricky; it’s possible to miss a dose, or not realize that an important new drug is missing from the regimen.
In some cases, the problem may be overmedication: not taking too little medicine, but too much. For one recent Residential Home Health patient who was struggling to improve while at home, RN Case Manager Louise turned to his prescriptions to find the cause. Learn how her medication assistance uncovered a common error and overhauled her patient’s outlook — and his life.
The patient was admitted to Residential Home Health for Parkinson’s disease management. Prior to admission, he had been doing so poorly that he was forced to sell his condo and move in with family. He was exhibiting trouble with speech (known as expressive aphasia), avoiding conversation and speaking in a flat voice, which his ex-wife (caregiver) confirmed was not his normal behavior. He was lethargic, sleeping and napping for long stretches of the day, and experiencing multiple falls. The patient was enrolled in the specialized LSVT Big & Loud program aimed at better speech and mobility. But even with physical therapy and occupational therapy, he was struggling to improve, and still falling several times per week.
Mastering Medication Management
Louise was puzzled that her patient was not showing more improvement in the program, and decided to perform an extensive medication reconciliation. Her investigation revealed that the patient was taking unusually large doses of two neurologic medications, both at bedtime, which together could have an extreme sedative effect and compromise his balance. While following up with pharmacists and physicians, Louise discovered that the patient was using two different pharmacies that were not in communication with each other and were unaware of the patient’s complete drug regimen.
After attempting to contact the neurologist who had prescribed one of the drugs, Louise reached out to the patient’s primary care physician, who returned the call right away to express his concern. He had not been aware of the dual high-dose prescriptions, and helped Louise to get more appropriate doses of both drugs on a better schedule. Eventually, his doctor and care team were able to discontinue both medications entirely.
Two Drugs Down, One Diagnosis Lifted
Following the adjustment, Louise returned to an engaged, smiling, laughing patient. He felt much better: not as lethargic, no more expressive aphasia, napping just once daily, and sleeping through the night. The patient’s falls ceased completely, his cognitive scores and balance improved, and his dementia diagnosis was eventually removed altogether.
The patient’s caregivers agree that he is getting back to his normal self, and his doctor is similarly thrilled. Once again able to ambulate confidently without an assistive device, the patient has become an active participant in his care and is working to get stronger. He fills his pill box and takes the correct medication at the correct time. And unlike at the start of care, he can respond to questions. There have been no falls in the several weeks since the medications were discontinued, so no more trips to the hospital. The patient’s family is ecstatic to have the father and grandfather they know and love back.
In addition to our comprehensive approach to medication management, Residential Home Health offers a range ofservices to help you work toward your health goals safely at home. Call (888)930-WELL (9355) to discuss your specific situation with a Home Care Specialist today, or click here to take our 60-second, 15-question Home Care Assessment.