New medication management guideline focuses on long-term care settings

Treatment—especially involving prescription medication—improves when an interdisciplinary team of healthcare professionals participates in care planning. Also, when trying to determine the reason for a resident’s change in functional status, caregivers should start by looking at the resident’s medications. Those are two points made in an updated evidence-based medication management guideline written by the University of Iowa College of Nursing and published in the Journal of Gerontological Nursing.

The new guideline, specific to long-term care settings, is an update to the original protocol published in 2004, according to Brenda Bergman-Evans, PhD, APRN-NP, APRM-CNS, chief nurse of the executive advance practice and project director of the Enhanced Care and Coordination Project at Alegent Creighton Health in Omaha, Neb. Experts try to update such guidelines wherever additional or new evidence arises, she added.

“The 2004 version provided general guidelines for maintaining function and decreasing polypharmacy, averting adverse reactions and evading inappropriate prescribing regardless of care delivery setting,” Bergman-Evans, first author of the original and updated guidelines, told Long-Term Living. The updated guideline, she added, “continued the same goals but specifically focused the plan on individuals residing in long-term care facilities and combined the assessment and outcome monitoring tool into a single, one-page document.”

The protocol is mainly directed at nurse practitioners but also could be useful to nurses, pharmacists, physicians and physician assistants who are part of interdisciplinary teams, Bergman-Evans said. It notes that although the final determination of whether a medication should be started, changed or stopped rests with the healthcare provider, all members of the interdisciplinary team caring for a resident—especially nursing professionals—should be included in the decision-making process.

“The administration and management of medications is a challenge and costly for long-term care facilities,” she said. “Review of the medication plan is an expected part of the mandated 60-day review process by healthcare providers. By regularly organizing and focusing this visit around making sure that the medication regimen is optimum for the resident’s current status, care will be improved, and, hopefully, the burden of mediations will be decreased.”

Bergman-Evans said she anticipates that the guideline will be updated again by 2017 as new research and data become available. The 2004 guideline also could be used as the basis of a new protocol to address the needs of older adults in community settings or those who are hospitalized, she added.

To complete this project, Alegent Creighton Health received one of seven four-year Centers for Medicare & Medicaid Services grants related to initiatives to prevent avoidable hospitalizations of long-term care residents. The monies were awarded in September 2012.

The guideline’s other author was Deborah Perry Schoenfelder, PhD, RN, who at the time of the writing of the guideline was associate clinical professor and editor at the John A. Hartford Foundation Center of Geriatric Nursing Excellence at the University of Iowa in Iowa City.

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Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.