As a nurse in long term care one of my concerns has been the prevalence of polypharmacy, the excessive use of medications. According to the NIH 50% of nursing home residents take 9 or more medications per day (2016). The problem is often related to the comorbid conditions of nursing homes elders such as heart disease, diabetes, chronic obstructive lung disease, and hypertension requiring multiple medication management. Many of the medications prescribed have not been tested in clinical trials with frail elders as research studies exclude nursing home residents related to their aging bodies and comorbid complexities. The problem of polypharmacy can also lead to serious interactions between multiple medications resulting in serious harm. Some medications increase the risk of confusion, falls, and behaviors in the cognitively impaired. Other risks of polypharmacy are excessive amounts of pills that must be passed by a nurse taking them away from resident care, therefore increasing the risk for a medication error and adverse drug event.
Interactions between medications prescribed, ineffective medications (too little and not enough), trial and error with multiple medications (trying to find the right fit), risk for side effects, cost of medications, time associated with med pass that takes nurse away from bedside, plus the impact on quality of life for residents, demands a new approach in assessing medication efficacy. Additionally, CMS regulations coming in 2018 regarding medication management and requiring diligent review, heightens the need for additional tools and resources for addressing the problem of polypharmacy.
A simple, straightforward solution is needed– one that offers providers a more effective tool that can align prescribed medications to the unique needs of each resident. I believe that pharmacogenetics testing provides such a solution.
Pharmacogenetic testing provides a very simple test that aligns a residents’ personal genetic profile with the medications they need. This alignment can enhance clinical impact and improve quality of life.
Testing starts with a doctor’s order and simple buccal swab. Within 72 hours a resident’s genetic profile is generated for assisting the physician in aligning present medications being taken, along with a roadmap for future medication prescribing. Reports are simple to understand and provide clarity for clinical teams plus peace of mind for residents and their families. It’s fully reimbursed for qualifying Medicare B participants.
When I’m asked “why pharmacogenetics testing makes sense?” my response is “based on the information available, and potential impact, why doesn’t it make sense?” Pharmacogenetics is an innovative tool that has the potential to transform the process of medication management in long term care, reduce polypharmacy, and ensure the efficacy of medications.
Dr. Linda M. Shell MA, RN
Legacy Market Services / LindaShell.com
