INJURY PREVENTION INSTITUTE

How Emergency Nurses Can Help Reduce Risk of ADEs Among Older Adults

The older adult population is the most affected by adverse drug events (ADEs). Emergency nurses can help decrease the risk of ADEs in ED patients by increasing their knowledge of medication safety. Patients, caregivers and health care providers often mistake adverse effects, such as confusion, forgetfulness, gait, instability, Parkinsonian signs, incontinence and fatigue, for new illness or aging.

ADEs among older adults usually are not the result of a single factor, but rather a combination of internal and external factors. Internal risk factors are associated with age-related changes. External risk factors are related to the physical environment.

The most-recognized internal risk factors for ADEs among older adults are medication interactions with food, supplements, alcohol, physical changes such as weight gain or loss, cognitive and psychological changes and nutritional deficiencies. Another internal risk factor relates to medication interactions with other substances including prescribed medications, OTC drugs, alcohol, vitamins, herbs, supplements and food.

Major external risk factors include the use of multiple health care providers and pharmacists, polypharmacy, the use of anti-infective, antipsychotic, antidepressant and/or opioid medications, misunderstanding of dosage instruction, poor patient-provider communication about medications, poor medication adherence, poverty and social isolation. New medications that are added to a patient’s regimen can increase the risk of an ADE. Adjustments to medications that are made during an ED visit or a hospital stay often are misunderstood by patients, resulting in an increased risk for ADEs.

To help older adults better understand their medication regimens, emergency nurses should encourage them to ask questions and know the facts about why they are taking a medication, dosage, schedule, length of therapy, potential food or drug interactions, potential side effects and potential adverse effects. Emergency nurses should ensure that their patients’ questions are answered and that they understand the dosage and directions for use prior to being discharged from the ED.

The Injury Prevention Institute’s SAFER Medication Use program may be ordered by visiting ENA’s Web site at http://www.ena.org/store/index2.asp?DEPARTMENT_ID=29.