Looking for the “Little Things”: A Multi-Disciplinary Approach to Medicines Monitoring for Older People Using the ADRe Resource

Abstract

Advances in medicines have increased the effectiveness of treatments and the social and cultural authority of doctors. However, as prescribing has become the dominant modality of treatment, the “pharmaceuticalization” of medical practice has often resulted in treatment “at a distance”, with doctors having limited contact with patients. Older and poorer people, who are socially distanced from medical prescribers, suffer more adverse drug reactions (ADRs) than the general population. A team approach to checking patients systematically for ADRs, as detailed in manufacturers’ literature, can minimise medication errors, but regular review is rare. This paper explains the benefits of medicines monitoring to protect older patients from iatrogenic harm, such as over-sedation, falls, or drug-induced Parkinsonism. We show how multidisciplinary initiatives to optimise prescribing can be supported by using a recognised resource—the adverse drug reaction profile (ADRe). The profile identifies and documents patients’ signs and symptoms of putative ADRs. Better monitoring allows professionals to adjust prescribing and respond to identified problems with agility. Implementation of systematic monitoring will require changes to the regulatory regime and better inter-professional cooperation. Providing carers, nurses and pharmacists with a structured system to monitor patients would democratise relevant medical knowledge and help address ageism and the socio-economic health divide.

Nobody ever questions—Polypharmacy in care homes: A mixed methods evaluation of a multidisciplinary medicines optimisation initiative

“…To succeed, despite organisational and professional barriers, discussions around de-prescribing need to be formalised and integrated into routine care [ 53 ]. Involving the staff spending most time with residents—nurses and carers—is crucial, and ADRe-p offers a feasible structure for enfranchisement and democratisation of medical knowledge [ 65 ].…”

“…Although authorities consider monitoring patients an essential component of prescribing, no structures are offered [ 52 , 59 , 60 ]. ADRe-p offers a workable structure, and is needed to support medicines reviews [ 2 , 3 , 52 , 60 , 65 , 75 – 77 ]. The proposed changes in primary care services, entailing weekly GP visits to care homes [ 78 , 79 ] will benefit from all information in a single shared document [ 52 ], rather than ~20 computer files.…”

“…Although authorities consider monitoring patients an essential component of prescribing, no structures are offered [52,59,60]. ADRe-p offers a workable structure, and is needed to support medicines reviews [2,3,52,60,65,[75][76][77]. The proposed changes in primary care services,…”

PRN Medicines Optimization and Nurse Education

“…This profile can be completed by nurses or carers alongside PRN medicines management, through the assessment of the patient’s health conditions, highlighting possible and probable ADRs on a single screen or sheet of paper, which is then passed to the pharmacist and physician. This informs a medication review process aiming at changing medications or their doses [ 41 , 86 , 118 ].…”

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“…To succeed, despite organisational and professional barriers, discussions around de-prescribing need to be formalised and integrated into routine care [53]. Involving the staff spending most time with residents-nurses and carersis crucial, and ADRe-p offers a feasible structure for enfranchisement and democratisation of medical knowledge [65].…”