Older adults are by far the largest users of medications. According to one national survey, 17-19% of adults aged 65 or older take at least ten medications (prescription or nonprescription drug, vitamin/mineral, herbal /natural supplement) in a given week.1 While medications surely help to improve their quality of life, preventing medication-related problems among this population is a serious concern. Each year, adverse drug events (ADEs) - harm resulting from the use of medication - result in over 177,000 visits to emergency departments by older adults.2 The cost for treating preventable ADEs among Medicare enrollees has been estimated at $887 million annually.3
Fortunately, there are existing strategies and techniques that can help prevent ADEs and other issues associated with poor medication management. Home health nurses are uniquely positioned to help reduce the risk of harm from medicines for older adults by implementing tools to review and monitor regimens, assess for side effects, communicate accurately and effectively, provide education on medication safety, and evaluate and address patient adherence.
1. Slone Epidemiology Center at Boston University. Patterns of medication use in the United States, 2006. Accessed December 20, 2012.
2. Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL. National surveillance of emergency department visits for outpatient adverse drug events. JAMA 2006;296:1858-66. Abstract.
3. Aspden P, Wolcott JA, Bootman JL, Cronenwett LR, eds. Preventing Medication Errors: Quality Chasm Series. Washington DC: National Academies Press; 2006. Abstract.
Geriatric Medication Management Toolkit
To help homecare professionals address one of the most challenging and complex problems confronting older persons with multiple chronic conditions -- managing multiple and high-risk medications -- CHAMP selected and organized evidence-based tools from our Resource Library into this online Geriatric Medication Management Toolkit. This Toolkit contains:
Clinically-focused and validated tools to help you, and patients and their caregivers, identify patients at increased risk of experiencing a medication-related problem;
Intervention tools for homecare professionals, patients and their caregivers, to facilitate implementing proven strategies to manage medications;
Tools to help you, patients, and caregivers communicate more effectively about medication risks with other providers; and
Guidelines and evidence-based best practices that provide an overview of the evidence for reducing medication-related problems and adverse drug events in older people.
This Toolkit was designed to provide you and your team with quick and easy access to best practice resources to reduce medication problems experienced by older patients and to help them take their medicines safely. CHAMP aimed to include a comprehensive list of tools (mostly items in the public domain), so we do not expect individual users to want/need every item in the Toolkit. To download and print tools individually, simply click on the name of the tool.
For Homecare Professionals
Beers Criteria Pocket Card - American Geriatrics Society - This tool, based on the updated AGS 2012 Beers Criteria for Potentially Inappropriate Medication Use In Older Adults, helps identify older patients who may benefit from medication regimen review and monitoring.
HbL Medication Risk Questionnaire - This 10-item self-administered questionnaire can help identify patients at increased risk of experiencing medication-related problems (MRPs). It may also help clinicians screen for patients who should receive a medication review. This tool was developed by Hedva Barenholtz Levy, PharmD of HbL PharmaConsulting.
Medication Management Instrument for Deficiencies on the Elderly (MedMaIDE™) - This 13-item tool helps to identify deficiencies in the ability of older patients or their caregivers to self-administer medications. A "yes" response scores 0, and a "no" response scores 1 in the deficiency score. Thus, the higher the total deficiency score, the less able the patient is to self-medicate. The tool also provides a section for the patient's full medication list. (The MedMaIDE was developed by Denise Orwig, PhD, Nicole Brandt, PharmD, and Ann Gruber-Baldini, PhD of the University of Maryland School of Medicine.)
Mental Status Assessment of Older Adults: The Mini-Cog - This simple screening tool, which takes approximately 3-5 minutes to administer, can uncover cognitive impairment in its earliest stages. It may help identify those at increased risk for poor medication adherence. (Published in Try This, Issue 3, from the Hartford Institute for Geriatric Nursing.)
Morisky Medication Adherence Scale (MMAS-8) © - This brief 8-item screening tool is used to assess adherence to chronic medications, such as antihypertensive drugs. It includes yes/no questions that address barriers to and behaviors associated with medication-taking. Scores of 0 to 5 imply low adherence. (The MMAS-8 was developed by Donald Morisky of the UCLA School of Public Health. Please contact prior to using.)
Questions to Consider when Evaluating a New Symptom in the Elderly - This set of questions can be used to assess whether a symptom in an older patient could be a medication-related problem. This tool has been used successfully by participants in CHAMP's Geriatric Medication Management course.
The ARMOR Tool - This tool consists of a stepwise approach to evaluate and reduce inappropriate polypharmacy (use of multiple medications) in geriatric patients. The five steps include: A = Assess the medications; R = Review for ADEs; M = Minimize non-essential medications; O = Optimize medications; and R = Reassess health status. (Haque R. ARMOR: A Tool to Evaluate Polypharmacy in Elderly Persons, Annals of Long Term Care, June 2009, Volume 17, Issue 6: p26-30).
For Homecare Professionals
Food/Drug and Drug/Nutrient Interactions: What You Should Know About Your Medications - This detailed guide helps educate patients about the potential for adverse interactions and how to avoid them (patients may need assistance reading/ comprehending).
Health Literacy Measurement Tools - This set of clinician tools quickly assesses the health literacy of patients and how much they understand so they can be helped to make appropriate health decisions. Includes both the Rapid Estimate of Adult Literacy in Medicine—Short Form (REALM-SF) and the Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50).
How To Create a Pill Card - This guide provides step-by-step instructions to create "pill cards" for patients who have difficulty keeping track of their medications and for patients with low literacy skills. It was developed by the Agency for Healthcare Research and Quality (AHRQ).
Improving Medication Adherence in Older Adults: What Can We Do? - This 2-page educational flyer summarizes common factors contributing to poor adherence and offers strategies to address them. It was prepared by the Virginia Health Quality Center.
Review of Medication Reconciliation Process - This set of slides briefly summarizes a 3-step process for Medication Reconciliation (identifying the most accurate medication list for a patient). They can be used for staff education.
Review of Pharmacological Pain Management - This set of slides briefly summarizes key principles of pharmacologic pain management for older persons. They can be used for staff education.
Teach-Back-Method Tool - This tool provides tips on using the Teach-Back Method - an effective strategy for healthcare providers to ensure that medication instructions are understood by patients. (Click here to view a 5-minute video that provides examples of using this method to help patients who have had medication changes.)
Avoiding Overmedication and Harmful Drug Reactions - This patient handout provides tips to help lower the chances of overmedication and related problems. It was developed by the AGS Foundation for Health in Aging.
Healthy Living: Food Can Affect Your Medicines - This easy-to-read fact sheet for older adults reviews foods and food groups that may need to be avoided when taking certain medications (also available in Spanish).
My Medicine List - This tool provides an easy way for patients/caregivers to keep track of and review medications with healthcare professionals (also available in French and Spanish). It was prepared by the National Transitions of Care Coalition (NTOCC).
NCPIE 6 Ways to Help Your Older Parents Use Medications the Right Way and Prevent Problems - This education tool for family caregivers provides 6 steps to get them started in playing an active role in managing their aging parents’ medications. It was developed by the National Council on Patient Information and Education (NCPIE) for their MUST campaign.
NCPIE Tips on Safe Storage and Disposal - This two-page handout provides useful tips on how to safely store and dispose of unused prescription medicine(s). It was developed by the National Council on Patient Information and Education (NCPIE).
Ten Medications Older Adults Should Avoid or Use With Caution - This two-page patient handout helps raise awareness of medications that may cause side effects or problems in older adults. It was prepared by the AGS Foundation for Health in Aging.
Tips for Preventing Problems When Taking Multiple Medications - This one-page patient handout helps prevent medication-related problems in older persons taking multiple medications. It was prepared by the AGS Foundation for Health in Aging.
For Homecare Professionals
Ask Me 3™ - This program helps foster effective communication with patients. It encourages patients to ask three simple questions during every medical encounter, and providers to answer them.
ASK Tip Sheet - This one-page tool helps start a discussion with patients about their use of complementary and alternative medicine (CAM), including herbal supplements.
Review of the SBAR (Situation-Background-Assessment-Recommendation) Technique - This set of slides briefly summarizes SBAR, an easy-to-remember technique for communicating information requiring action (such as between a home care nurse and a physician about a particular patient medication issue).
SBAR (Situation-Background-Assessment-Recommendation) Worksheet - This one-page worksheet summarizes the 4 steps of SBAR, an easy-to-remember technique for communicating information requiring action. It can be printed and filled in to help plan an upcoming communication.
Script for Adherence Counseling - This script helps clinicians working with patients with chronic diseases improve adherence to prescribed medications. It includes a section on Motivational Interviewing with questions to help assess patient motivation and confidence levels.
Scripts for Medication Reconciliation - Using scripts to ask patients about all of the medications they are taking (including over-the-counter preparations) can improve the "Verify" step of a Medication Reconciliation. These example scripts have been used successfully by participants in CHAMP's Medication Management course.
Empowered Patient Coalition SBAR (Situation-Background-Assessment-Recommendation) Form - This version of the standardized communication tool was designed for patients and their advocates relay vital information to health care professionals.
NCPIE Questions to Ask Before You Leave the Doctor's Office - The National Council on Patient Information and Education recommends that patients or their caregivers ask these 6 questions when they are given a new prescription.
Your Medications - What to Ask - This one-page patient handout facilitates communication with health care providers about medication concerns.
American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults - This is an updated and expanded version of the well-established Beers Criteria to help healthcare professionals identify older patients who may benefit from monitoring or medication review. (Click here to read CHAMP Pharmacy Expert Dennee Frey’s blog post about the updated Criteria)
Best Practices Evidence Brief: Medication Management - This brief discusses the importance of medication safety and adherence in older persons and summarizes effective interventions to improve adherence and reduce adverse events. It was developed by the Visiting Nurse Service of New York's Center for Home Care Policy & Research as part of a National Framework for Geriatric Home Care Excellence.
Nursing Standard of Practice Protocol: Reducing Adverse Drug Events - This protocol for reducing adverse drug events in older adults includes assessment tools and strategies, interventions, expected outcomes, and references. The content, published in Evidence Based Geriatric Nursing Protocols for Best Practice, is accessible from the "Want to Know More" section of ConsultGeriRn.org by the Hartford Institute for Geriatric Nursing, at New York University's College of Nursing.
To find more free Medication Management tools to use with your staff, your patients, and their caregivers, visit the CHAMP Tools page and select "Medication Management" from the topics drop-down menu.