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Medication Errors in Assisted Living Facilities

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Q. I have been a critical care nurse for more than 30 years and recently started monitoring assisted living facilities for the state. Most medication errors are made by their medication technicians. These employees may have completed only four hours of training. Assisted living residents themselves are often not capable of identifying their medications because they have dementia, schizophrenia or depression.

Physicians and nurse practitioners prescribe the drugs, with some residents taking ten to fifteen pills at one time in the morning. Most of us couldn't tolerate so many drugs without side effects such as upset stomach, diarrhea or constipation.

If a sedative or a psychotropic drug is added, it increases the risk of falling. Then the patient may be hospitalized with a fractured hip or head injury. There should be better monitoring of such facilities.

A. We share your concerns. Training requirements for medication techs vary from state to state. Many older people in assisted living facilities cannot protect themselves from overmedication. Family and friends need to be vigilant to prevent the kinds of accidents you have described.

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13 Comments

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I hear you! My mother lived in an assisted living center and I managed her medicines. Even then, she would take double her thyroid medicine, double up on Ambien, etc. from the next day's supply. When I had the assisted living center dispense her medications, things were better. Yet, I would arrive and find pills on the floor and in her sheets and on the chair. They did NOT make sure she didn't drop a pill and therefore miss it.

My mother passed away in April but I still wonder how that could have been handled better.

THIS is why my 82+ mom will NEVER get in the clutches of sicko Western medicine drug-pushers!

Yes, Med techs are only trained to read the label and push the pill. They have no knowledge of side effects or drug interactions. Much of the problem lies in the NUMBER of different medications given. If the client is lucky enough to have a family, they may want to be familiar with the meds. Look them up. Ask their pharmasist to give them information. Be sure they are not taking more than one drug for the same condition. Check dosages; are they too large for an elderly patient; a small patient who may weight only 90 lbs.? Could one drug interact with another? Nothing is worse for an elderly person than POLYPHARMACY! Speak with your relative's Dr. and request that certain meds. be removed by cutting dosages one at a time to prevent "rebound" and withdrawal. Withdrawal can be very serious in anyone, depending on the drug being removed, but worse in the elderly. Having worked for several years in nursing homes, I have witnessed all of the above and it is worse now than it was than. Drug companies want Drs. to write those perscriptions. Please be an advocate for your captive relative.

As you mentioned... Physicians and nurse practitioners prescribe the meds..... I truly believe over medication is a BIG problem not just in nursing homes but to the general public! Taking multiple meds surely must react with each other and than you are likely prescribed another med to treat the side effects!

Everyone could use a lesson on when and how to take their medications and to monitor for side effects. Doctors need to understand that often Less is More. People need to take responsibility for conditions they may be able to treat without first relying on medications. And for our loved ones in nursing homes, family needs to be involved and have a current medication list made available to them. Thank you for your Q/A

A cautionary tale. If you ever do choose to go into assisted living or a nursing facility I really hope you'll make certain ahead of time through a contract that's legal for someone you trust to oversee you receiving your meds and general wellness daily. It's so important, Mimi. And please pass it on.

This is a real problem! I just read a great article on the AARP website about a pharmacist who is fighting this problem. It's worth checking out: http://www.aarp.org/health/drugs-supplements/info-06-2011/armon-neel-pharmacist-who-says-no-to-drugs.html

My Mom is in a nursing home. A Skilled Nursing Care Facility. Nurses dispense the meds. And STILL, you would not believe how often they dont give them to her or they forget some or they continue giving her things they shouldnt. If someone werent there with her every day, we wouldnt have even know how bad the errors & carelessness are. We had to escalate quite high to get some attention to the problem, a few disciplenary actions, but in general, unless we are giving them ourselves we cannot be sure they are correct. It is a VERY SAD state of affairs how poorly are sick & elderly are treated.

I am appalled at the lack of training & oversight in some ass't. living facilities in SC. A friend was prescribed 30 mg. of Cymbalta by the "house physician" because she was rude & unco-operative towards personnel. This didn't work, so he inc'd it to 60 mg. for a 110 lb 79 yr. old! She began complaining of severe back & leg pain, lack of appetite,incontinence and she began falling 5+ times a day. NO ONE seemed to notice. If the med. techs. knew about it, they didn't know enough to report it & no nurse ever checked. It took a routine visit to the resident's neurologist to stop this lack of over-sight. With a gradual reduction to 0 Cymbalta, all the symptoms went away. Now, the staff is not happy because she's her usual "unfriendly" self again.

This information isn't very helpful for people in Assisted Living or Nursing homes. There are many people who have no family, and others whose family just don't want to bother. We need something done to help these people.

Ugh! Why do doctors just seem to prescribe anything and everything to the elderly? We are going through a scenario now where my 75 year old mother fell at home and bruised her hip badly. We finally convinced her rehab doctors to look at all the meds she was on, most of which caused dizziness, drowsiness, and increased fall risk. Other than low thyroid and a little high BP, she is in otherwise good health but all these meds have caused her to be primarily housebound, unable to drive, and basically unable to properly take care of her self and her affairs.

75 is too young to be in such a state because of medication and doctors seem all to ready to whip out those prescription pads.

When my dad became totally disabled because of Parkinsons, he was initially sent to a skilled nursing facility. It was so bad I had to stay physically beside him to assure everything that was supposed to be administered was. After 5 days I took him home and cared for him myself until he passed away. What I learned from that experience and the following hospitalizations is that if a patient cannot speak for himself, he needs a full-time advocate who can monitor treatment and medication.

I agree, however when my dad was in a rehab/nursing home facility the family did complain about the medications and how they were dispensed. (or lack of dispensing).

The 1st day there he did not get his Parkinson medication. He skipped a dose. We complained and the nurse said to us "If you do not like it you can take him out of here". My dad had dementia, Parkinson's and was blind. Nurses dispensed the medication. There was once when they swore he got his dementia meds because it was recorded, yet we knew he did not. Someone from the family was with him for 12 hours straight. When my dad was released he was over sedated. My dad died withing a month of being in the facility.

What do patients do that have no family nearby?

Safeguards need to be in place to prevent these horror stories. The families sometimes don't know enough about meds to challenge anything. Others feel intimidated. My mother-in-law just passed away after a four-month stint in a Texas nursing home where apparently the only requirement for employment is that the applicant must have a pulse.

I think Texas requires medication dispensing in a nursing home be done by a nurse or a certified medication aide. The medication aide is only as good as the training they acquired during the short stint in "school."

I observed a medication aide give pills to my mother-in-law with barely a couple of ounces of liquid, then put her back
into a lying-down position on her bed. When the aide left the room I put Mom into a sitting position and gave her more water, then kept her sitting up for about 15 minutes. Even a vitamin can cause esophageal erosion if it just sits there long enough and doesn't go down. Because of that kind of "medication administration" I bet a ton of people in facilities are on any number of meds to reduce or block stomach acid production - Zantac, Prilosec, etc., and those meds can cause a host of other problems.

I think it would help a lot to implement medication changes, additions, discontinuations, etc., only with the RPh being involved in the process. Most pharmacists know more about medications than doctors and nurses will ever know, and their input could keep these old people from being over- under- or unnecessarily-medicated. And if a pharmacist challenges a doctor on medications, the doctor is less likely to get into a hissing contest with the RPh than if a nurse challenges a doctor.

I have another horror story that involved my sister on a visit to the ER years ago. When the Dr. left the room, he said he would have the pharmacy send something up for pain. When they brought Lortab my sister told them she hallucinates on that med. The nurse took it back to the pharmacy and came back shortly with another big white pill and I asked what it was. She replied "Vicodin." This was a Registered Nurse! (I am but a mere Certified Pharmacy Technician.) When I challenged it, asking the R.N. why they were giving her the same thing they'd just been told caused hallucinations, it was like headlights on a deer. My instinct was to run screaming from the building, but I had to stay with my sister to make sure they didn't kill her! Sigh.........

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