FOR YOUR INFORMATION
This article was reprinted with permission from Try This: Best Practices in Nursing Care to Older Adults from the John A. Hartford Foundation Institute for Geriatric Nur sing, Issue 16, aspan of the Nurse Competence in Aging initiative. Mathy Mezey, EdD, RN, FAAN is Director of the Institute and Terry Fulmer, PhD, RN, FAAN is Co-Director. Series Editor: Sheila Molony, MS, APRN, Connecticut Community Care, Inc.
Address correspondence to the John A. Hartford Foundation Institute for Geriatric Nursing, New York University, Steinhardt School of Education, Division of Nursing, 246 Greene Street, 5th Floor, New York, NY 10003, or call (212) 998-9018, or fax (212) 99Í-4Í61, or e-mail firstname.lastname@example.org, or access the Web sue at http://iiww.hartfordign.org.
Recently published studies confirm that inappropriate medication use remains a serious problem for older adults (Meredith et al., 2001; Sloane, Zimmerman, Brown, Ives, & Walsh, 2002; Zhan et al., 2001) Increased nursing awareness of high-risk medications enables attentive monitoring for adverse effects and facilitates collaborative efforts between nurses, primary care providers, and pharmacists to reduce medication-related risk.
The adapted Beers' Criteria (Beers, 1997) identifies medications noted by an expert panel to have potential risks that outweigh potential benefits of the drug. The criteria are appropriate for persons older than age 65, regardless of their level of frailty. The criteria provide a rating of severity for adverse outcomes (severe vs. less severe) as well as a descriptive summary of the prescribing concerns associated with the medication.
VALIDITY AND RELIABILITY
The criteria were developed using a modified Delphi method to achieve consensus among six nationally recognized experts in geriatric care and pharmacology. The criteria have been used alone and in combination with setting-specific criteria to screen populations for possible medication-related problems. Further research is needed to validate the occurrence and severity of negative outcomes associated with high-risk medications.
STRENGTHS AND LIMITATIONS
The criteria do not identify all cases of potentially inappropriate prescribing and they may sometimes identify appropriate prescribing as inappropriate. The criteria are designed for population-based screening and are not intended to substitute for professional judgment regarding the individualized needs of particular older adults.
Nurses may use the criteria to increase awareness of medications that may present increased risk for adverse drug reactions. Nurses, primary care providers, and pharmacists may collaborate to optimize individualized medication regimens and provide appropriate clinical monitoring and education. The references provide further information on high-risk medications specific to patient diagnosis and prescribing practices in specific care settings.
- Beers, M.H. (1997). Explicit criteria for determining potentially inappropriate medication use by the elderly. Archives of Internal Medicine, 157, 1531-1536.
- Meredith, S-, Feldman, P.M., Frey, D., Hall, K., Arnold, K., Brown, N.J., & Ray, W.A. (2001). Possible medication errors in home healthcare patients. Journal of the American Geriatrics Society, 49, 719-724
- Sloane, P. D-, Zimmerman, S., Brown, L. C-, Ivés, T. J. & Walsh, J.F. (2002). Inappropriate medication prescribing in residential care/assisted living facilities. Journal of the American Geriatrics Society. 50, 1001-1011.
- Zhan, C., Sangl, J, Bierman, A3, Miller, M.R., Friedman, B., Wickizer, S.W., Meyer, G.S- (2001). Potentially inappropriate médication use in the community-dwelling elderly: Findings from the 19% Medical Expenditure Panel survey. Journal of the American Medical Association, 286, 2823-2829.
- MORE ON THE TOPIC
- Brown, N.J., Griffin, M.R., Ray, W.A., Meredith, S., Beers, M.H" Marren, J., Robles, M, Stergachis, A., Wood, A.J.J., & Avorn, J. (1998). A model for improving medication use in home health care parions. Journal of the American Pharmaceutical Association, 38(6), 696-702.