Polypharmacy In Adults: Small Test of Change Brandi Malsy, RN, BSN 7940 Evidence-Based Practice III April 8, 2014 My name is Brandi Malsy. Today is April 8, 2014 and my evidence-based practice project title is Polypharmacy among adults.

Introduction What is polypharmacy? PICO Question Literature Review and Evidence-Based Practice Recommendations Small Test of Change Small Test of Change Results Conclusion Small Test of Change vs. Primary project

Polypharmacy Polypharmacy- The use of multiple medications by a single individual Polypharmacy is becoming an increasingly serious problem Older adults and elderly are affected more by the harmful effects of polypharmacy The harmful effects of polypharmacy are preventable The use of multiple medications, or polypharmacy, is becoming an increasingly serious problem within the healthcare system, particularly within the older adult and elderly population. Older adults and elderly are affected more by polypharmacy due to the aging process, prevalence of chronic diseases, and the overall lack of knowledge regarding their daily medication regimen. The harmful effects of polypharmacy can be prevented by identifying individuals at risk, providing education regarding safe medication usage, and encouraging patients to participate in their care.

PICO Question P-In adults, age 50 and above with polypharmacy use I- how does providing enhanced patient education regarding safe medication usage and the importance of patient communication and collaboration with healthcare providers C- compared with routine medication education improve the patient’s overall knowledge of medication safety O- reduce the occurrence of unnecessary polypharmacy, and prevent ADRs? The PICO question that guided my literature review for my EBP project is: In adults, age 50 and above with polypharmacy use how does providing enhanced patient education regarding safe medication usage and the importance of patient communication and collaboration with healthcare providers compared with routine medication education improve the patient’s overall knowledge of medication safety and reduce the occurrence of unnecessary polypharmacy, and prevent ADRs? The population chosen is adults, age 50 and above with polypharmacy use medication The intervention is providing enhanced patient education regarding safe usage and the importance of patient communication and collaboration with healthcare providers The comparison component of the PICO question is compared with routine medication education improve the patient’s overall knowledge of medication safety The desired outcome is a reduction of the occurrence of unnecessary polypharmacy, and prevent ADRs?

Evidence-Based Practice Recommendations 1) Encourage patients to maintain and bring an up-to-date list of all medications they are taking to every physician visit- Grade A Recommendation 2) Healthcare providers should conduct a medication review and clarify indications of medications at every visit- Grade A Recommendation 3) Encourage patients to participate in their care, and ask questions when necessary- Grade B Recommendation 4) Encourage patients to use only one pharmacy- Grade B Recommendation Based on the critical appraisal of evidence, the following evidence-based practice recommendations were gathered: ……. The likelihood of harmful effects due to polypharmacy are increased when a medication list is not maintained by the patient, (American Geriatric Society, 2012). ….. According to It is found when medication reviews, along with each medications’ indications clarified, are routinely conducted by healthcare providers, a decrease in ADRs is seen. ….. When patients are encouraged to participate in their care, patient-provider communication is strengthened. Good patient-provider communication allows for the patient to feel comfortable enough to ask questions during their visit. Encourage patients to use only one pharmacy……..It is shown the more pharmacies a patient uses, the higher incidence of harmful effects of polypharmcy, such as falls and ADRs can be seen, especially within the older adult population.

Polypharmacy: Small Test Of Change Men and women, over the age of 50, in the primary care setting who are taking five or more medications daily Polypharmacy Self-Assessment completed by participant Medication education provided Participants reassessed in 3-4 weeks Pre and post medication education groups compared using paired t-tests Sum scores for Likert-scales calculated … The polypharmacy self-assessment questionnaire consisted of 15 questions **Medication education was provided for patients using the Care Notes program **Participants were reassessed in 3-4 weeks by follow-up phone call.

Polypharmacy STOC Results Eighteen participants 56% Male, 44% Female 100% Caucasian Ages ranged from 52-81, with mean age of 62 (s.d. +/- 7.22) Average number of medications taken: 10 Average number of physicians seen: 3 Average number of pharmacies used: 2 Descriptive statistics were used for demographic variables and pre and post scores were analyzed using paired t-tests for individual questions.

Improvement in Confidence Levels Sum scores for questions relating to patients’ confidence levels on their understanding of their medication regimen and proper medication usage, confidence level in communicating with healthcare providers, and confidence level in accessing physician’s office and pharmacy were calculated. **Medication questions focused on the patients’ ability to describe each medications purpose, directions, and side effects. ** Communication questions focused on the patients’ confidence level in communicating with their physician, nurse, and pharmacist. ** Access questions focused on the patients’ confidence level in accessing their physician office and pharmacy at all times A Likert-scale was used to answer the questions, ranging from 1-10, with 1= Not at all confident and 10= Extremely confident. **Based on the answers of the pre and post questionnaires provided to patients, significant improvements were seen in all areas except the patients’ confidence level accessing their physician office and pharmacy, however, when combined for the sum scores, these areas showed significant improvement.

Conclusion Significant results seen in small test of change project. Providing enhanced medication education and encouraging patient-provider communication improved patients’ confidence level in areas such as their medication regimen and improved confidence levels when communicating with healthcare providers in the primary care setting.

STOC vs. Primary Project What particular medications patients need additional information on What factors hinder communication between patients and healthcare providers What factors hinder patients’ confidence level regarding accessing their physician’s office and pharmacy

References American Geriatrics Society 2012 Beers Criteria Update Expert Panel(2012). American geriatrics society updated beers criteria for potentially inappropriate medication use in older adults. The Journal of American Geriatric Society, 60(4), 616-631. doi:10.111/j.1532-5415.2012.03923 Beers, M. H., Ouslander, J. G., Rollinger, I., Reuben, D. R., Brooks, J., & Beck, J. C. (1991). Explicit criteria for determining inappropriate medication use in nursing home residents. Archives of Internal Medicine, 151, 1825-1832. Bushardt, R. L. Bergman-Evans, B. (2006). Clinical practice guideline: Improving medication management for older adult clients. Journal of Gerontological Nursing, 32, 6-14.

References Chandra, A., & Gerwig, J. (2007). Addressing the Challenges Associated with Polypharmacy and Adverse Drug Events: identifying Preventive Strategies. Healthcare and Public Policy, 85(7), 29-34. doi:10.3200/HTPS.85.4.59-34pp29- 34 Massey, E. B., Simpson, T. W., Ariail, J. C., & Simpson, K. N. (2008). Polypharmacy: Misleading but manageable. Clinical Interventions in Aging, 3(2), 383-389. Riker, G. I., & Setter, S. M. (2012). Polypharmacy in Older Adults at Home-What it Is and What to Do About It. Home Health Care Nurse, 30(8), 474- 484.doi:10.1097/NHH.0b13e3186502dd

References Steinman, M. A., Landefeld, C. S., Rosenthal, G. E., Berthenthal, D., Sen, S., & Kaboli, P. J. (2006). Polypharmacy and prescribing quality in older people. Journal of the American Geriatric Society, 54, 1516-1523. doi:10.1111/j.1532-5415.2006.00889.x