Abstract
Advances in medicines have increased the effectiveness of treatments and the social and cultural authority of doctors. However, as prescribing has become the dominant modality of treatment, the “pharmaceuticalization” of medical practice has often resulted in treatment “at a distance”, with doctors having limited contact with patients. Older and poorer people, who are socially distanced from medical prescribers, suffer more adverse drug reactions (ADRs) than the general population. A team approach to checking patients systematically for ADRs, as detailed in manufacturers’ literature, can minimise medication errors, but regular review is rare. This paper explains the benefits of medicines monitoring to protect older patients from iatrogenic harm, such as over-sedation, falls, or drug-induced Parkinsonism. We show how multidisciplinary initiatives to optimise prescribing can be supported by using a recognised resource—the adverse drug reaction profile (ADRe). The profile identifies and documents patients’ signs and symptoms of putative ADRs. Better monitoring allows professionals to adjust prescribing and respond to identified problems with agility. Implementation of systematic monitoring will require changes to the regulatory regime and better inter-professional cooperation. Providing carers, nurses and pharmacists with a structured system to monitor patients would democratise relevant medical knowledge and help address ageism and the socio-economic health divide.
Highlights
The benefits of improved medicines developed over the past century [1,2] have been eroded by an increasing incidence of iatrogenic disease arising with the unwanted effects of prescribed drugs [3,4].The European Medicines Agency [5] defines an adverse drug reaction (ADR) as a “noxious and unintended” reaction to a medicinal product
This includes ADRs that arise from both use of a medicinal product within the terms of the marketing authorisation, and use outside the terms of the marketing authorisation, including overdose, off-label use, misuse, abuse and medication errors, as well as occupational exposure [5]
adverse drug reaction profile (ADRe) was developed from earlier research on nurse-led medication checking, originally in relation to mental health medicines prescribed for clients of community mental health teams [48,49,50]
Summary
The benefits of improved medicines developed over the past century [1,2] have been eroded by an increasing incidence of iatrogenic disease arising with the unwanted effects of prescribed drugs [3,4]. The adverse drug reaction profile (ADRe), allows care home staff periodically to record the signs and symptoms of adverse effects of commonly prescribed medicines by completing a paper instrument—a kind of carer administered checklist. It is structured so as to allow detection of common ADRs and provides nurses and other non-prescribers with information to link signs and symptoms on the checklist to prescription medicines. This offers personalised information and evidence that they can bring to the attention of prescribers so as to facilitate improved medicines management [6,7]. ADRe provides a systematic means of improving drug safety in primary care, while encouraging new forms of multidisciplinary working that will help to reduce the “care gap” [8] that affects so many older care home residents
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