The ultimate goal of today’s presentation is to be able to understand the common factors/themes occurring in elderly medication incidents as well as prevention techniques.

General background about why it is important for elderly patients to be aware of their medications, why they are more likely to have medication error incidents.

These statistics show that many senior patients are on many different medications at the same time.

As person ages, their organs such as kidneys and liver function may decrease and not be at the best capacity. This may cause accumulation or lack of process of medications in the body. This in return can produce unwanted effects. Elderly patients are vulnerable to certain medications, although they may not know what types of medications to avoid, they are encouraged to speak to their pharmacists or doctors to determine if their current medications or new medications are appropriate for them. As a person ages, their body is also more sensitive and susceptible to certain medications.

Aggregate Analysis: ISMP Canada retrieved 265 medication incidents that has been reported to them across Canada and summarized the common factors/themes related to elderly medication errors. These 4 themes are some of the most common reoccurring themes related to elderly medication errors.

Allergies are often overlooked and under considered Allergies are often overlooked and under considered. It is important for patients to be able to clearly communicate with their health care providers and pharmacists about their allergies to avoid unwanted effects. Reasons for allergies to be overlooked is due to wide range of indications of medications. Some medications can often have cross reactivity (cross allergy) with other medication. Specific example is the sulfonamide chemical group. Sometimes medications with entirely different names from different classes of treatment may share the same chemical group! Example provided in the next slide.

Example of incident where allergy was not clearly communicated between the health care professionals and the patient. Fortunately in this incident, the patient did not experience any harm.

Medications (Examples) Table 1: Medications with potential cross-reactivity with sulfonamides. (Note: This is not a comprehensive list.)3,4 Therapeutic Category Medications (Examples) Antibiotics Trimethoprim-sulfamethoxazole Medications for Inflammatory Bowel Disease Sulfasalazine Anti-inflammatory Celecoxib Anti-diabetic Agents Glyburide Gliclazide High Blood Pressure/Water Retention Furosemide Hydrochlorothiazide Headaches Sumatriptan Examples of medications with cross-allergies. For example if person A has allergies such as rash/hives to Trimethoprim-sulfamethoxazole (antibiotics), he has a potential cross-allergies to Furosemide (a water pill for water high blood pressure or water retention). These drugs are from completely different classes for different treatments. They do not sound or look familiar in their name as well. Bottom Line: Communicate and talk to your pharmacist and doctor about your allergies and nature of your allergies. They can use this information to help determine if the medication is appropriate for you.

Blister packs, also known as compliance packs, are given by pharmacies to help patients with compliance and adherence. Blister packs are vulnerable to errors. This is commonly seen when packaging or dispensing medications with frequent dose changes, such as warfarin, levothyroxine, and pain medications.

Incident where medication was unintentionally moved to another slot.

Incident of unintentional labelling error.

Other blister pack errors, drug missing from the package, duplication (two of the same medication in the blister or slot unintentionally), labeling errors. While these errors may not have occurred in your blister package, it is recommended that you always check your packaging for correct labels and your medications before you leave the pharmacy in order to minimize the risk of errors. If you have questions about your medications, ask your pharmacist.

Due to the higher number of medications an average older adult may take when compared to younger individuals, the potential risk of medication errors also increases. Multiple medications may cause confusion for both patients and pharmacy staff, especially after a change in therapy, dose, strength, or type of medication, etc.

Incidence where there is a lack of communication between the patient and the prescriber. The patient was not communicated properly about stopping a medication before initiating the new medication, causing low blood sugar and unwanted risks.

Always have a clear understanding of why you are taking your medication(s). Communicate with your health care providers and pharmacist will help minimize medication errors. If you have any questions about your medications, ask your pharmacist. Never make assumptions about the use of your medication(s).

Medications often comes with different strength and various formulations. These formulations are often noticed by the different abbreviations or suffixes after the name of the drug, for example, CR, LA, DS, EC. Although some medications may have the same chemical name, with the different suffixes, the rate of release and activities of the drug in your body may vary. Always check with your doctor or your pharmacist if you have any questions regarding the drug formulation or if you notice any difference in the suffix/abbreviation of your medications in between your refills.

Incident where formulation differences was not noticed – potential for harm.

Education, education and more education Education, education and more education. Having self awareness and knowledge about your medication(s) is important in identifying medication errors before they occur. Communication – essential between patients and healthcare providers. Patients should have a proactive approach in asking questions about their medications (refer to next slide).

This slide contains MIPS version of the 5 Questions to Ask This slide contains MIPS version of the 5 Questions to Ask. It is a good idea to introduce this tool to senior population during presentation.