Adverse Drug Reaction

An adverse drug reaction (ADR) is an unexpected, unintended, undesired, or excessive response to a medicine that 1) requires discontinuing the medicine or changing the medication therapy, or modifying the dose (except in minor dose adjustments), 2) necessitates admission to a hospital, or supportive treatment, prolongs stay in a health care facility (HCF), 3) significantly complicates diagnosis, or negatively affects prognosis, and finally, 4) results in temporary or permanent harm, disability, or death.

The frail elderly are at a significant higher risk of developing ADR from medications. However, reporting ADR in the elderly remains a challenge because of their underlying medical conditions.

How are ADR reported in your facility? Is there a policy that is comprehensive, and easy to use? How often is it being used? Is the consultant pharmacist responsible for ensuring an overall education of the staff regarding ADR? Furthermore, is suspected ADR reported and investigated and discussed?

A staff member or a single member of the interdisciplinary team should not shoulder the burden of establishing an ADR; suspected ADR should be reported, and then investigated by a committee. The committee will then rule-in or rule-out the particular ADR. The cascade that may ensue from misattributed ADR on the disease management should not be underestimated.

Medication Errors

Medication errors, highly publicized are every healthcare professional’s nightmare. In the geriatric population, medication errors compounded with the frailty of the patients can have significant if not catastrophic outcomes. Monitoring these events in the nursing skilled facility is not just essential, but also incumbent on good clinical practice.
Medication errors can  be the results of poor prescribing, sloppy transcriptions, error in dispensing, and /or error in administration. In essence throughout the entire process, the potential for error lurks.

Do you have a method by which you can quantify these medication errors? do you encourage reporting and self-reporting especially near-miss events? Once tracked, do you have a committee or a group that analyzes the trend? and finally, once armed with all that information what is your plan?

Support to engage the medical staff and residents/patients in nursing facilities or acute care centers is available to reduce the potentiality of costly errors. The Institute for Safe Medication Practices (ISMP) could provide help, your consultant pharmacist can be a great asset in not just reporting the errors found during a chart review, but in analyzing the data and providing a plan of action to reduce what we all wish never happens.

Medication Regimen Review

Medication review or medication regimen review (MRR) is the cornerstone of the consultant pharmacy services.

MRR should contribute to improving therapeutic outcomes, quality of life, and at an optimum maintaining functional status. In addition, MRR should help reduce adverse events and health care cost by reducing hospitalization and emergency room visits.

MMR comes in three major types:

1. Prospective MRR-review performed upon admission or initiation of new therapy.
2. Concurrent MRR-review while therapy is in progress that continuously assesses the resident's medication therapy.
3. Retrospective MRR- review performed after the therapy been discontinued or resident been discharged.

Having a method that empowers the facility staffs; physicians, nurses and administrators to evaluate the medication therapy by evaluating the MRR outcomes becomes essential. For example, an impact report, that performs a trend analysis of the recommendations made by the consultant pharmacist and the replies received from the various departments, will provide the facility with tools to improve medication quality.

In addition, understanding the types of MRR; their capacities and limitations can provide a way to maximize the potential outcomes of these reviews. A conversation should take place with the consultant pharmacist and action plan put in place to improve therapeutic outcomes of the residents.