年度国家精品课程(网络教育)申报 ...ppt

Updated Surveyor Guidance on Medications: F329 Steve Levenson, MD, CMD OVERVIEW Medications and Long-term Care Medications are an integral part of long-term and subacute care Administered to try to achieve various outcomes, for example Curing acute illness Diagnosing disease or condition Arresting or slowing disease process Reducing or eliminating symptoms Preventing disease or symptoms Prevalence of Medications Study of 33,301 nursing facility residents in 2000 Average of 6.7 medications per individual Twenty-seven (27) percent of residents on nine or more medications. Prevalence of Medications Report (2001) Fifty-eight (58) percent of 693,000 residents who received antipsychotics either Lacked appropriate indications for use or Received doses exceeding maximum recommended dosage levels, including duplicative therapy Medication Benefits and Risks Medications can stabilize or improve outcome, quality of life, and function Any medication can have adverse consequences Potential to increase risk of adverse consequences Without adequate indications Excessive dose Excessive duration Without adequate monitoring Taking Medications Seriously Scope of the Problem Medications are well-known public health problem Described in the medical, nursing, and pharmacology literature for many decades Discussed repeatedly in the mass media Relevant in every setting Source: Parade Magazine, March 12, 2006 Why Focus on Problematic Drugs? J Amer Bd of Family Practice, 95; 8:195-205, Ackerman et al. “It is safe to assume that many of our nursing home patients are suffering from drug side effects, drug interactions, or both.” “Careful review and pruning of the medication list could be the single most important service the clinician can provide to his or her nursing home patients” Ann Internal Medicine, (10/92), Vol. 43, No.4, Beers et al. Inappropriate medication prescribing common in NHs ADRs Increase With Number of Medications Warnings on Antibiotics “Antibiotics may s