In late March of 2012, the Centers for Medicare & Medicaid Services (CMS) started the National Partnership to Improve Dementia Care and Reduce Unnecessary Antipsychotic Drug Use in Nursing Homes. This organization has been commonly referred to as the Partnership to Improve Dementia Care in Nursing Homes. Antipsychotic drugs are those used to alleviate the behavioral and psychological symptoms of those with disorders of the mind, namely Alzheimer’s and dementia.
The goal of this Partnership is to enhance the quality of life of American residents in nursing homes. Previously, it has been common practice to use numerous types of psychopharmacological medications in nursing homes to address behaviors (without first determining the cause in which these behaviors developed.) These behaviors are commonly associated with symptoms of anxiety, depression, psychological distress, and insomnia all of which can be addressed without antipsychotic drugs, and their adverse effects (sedation, parkinsonism and increased risk of: infections, falls, strokes, etc.)
The primary concern with the use of medications, like antipsychotics, is that nursing homes and other medical facilities are using these drugs as a “quick fix” for behavioral symptoms. The Partnership to Improve Dementia Care in Nursing Homes recognizes that there are instances in which antipsychotic drugs are needed, but only after:
- Specific and documented therapy
- Ongoing examination of the resident to assess effectiveness and any development or presence of adverse effects from the medication
When a case for these drugs is concluded the medication should be administered only for the duration needed, and at the lowest effective dose. Often, these drugs are not necessary after using more holistic approaches to solving these behavioral issues – through a more thorough, individualized assessment of underlying sources.
The intolerance, hostility, delusions, apathy and sleep troubles these Alzheimer’s and dementia patients encounter can be solved with alternatives to antipsychotic prescriptions. Holladay suggests first trying non-drug treatments such as reminiscence therapy and social interaction. Research implies that various symptoms can be decreased by simply 10 minutes of individualized, daily talking therapy. Treatments including aromatherapy, animal therapy, music, dance, and massage therapy can also significantly lessen unfavorable behavior.
For more information on Alzheimer’s and dementia treatment options feel free to speak with a knowledgeable Holladay accociate at 336-760-3446.
Tramadol is a narcotic-like drug used to treat moderate to severe pain. Like many opioid analgesic based medications, tramadol has an increased abuse rate and as of August 18, 2014, the DEA has classified the medication as a schedule IV controlled substance.
In the past, it was widely believed that tramadol had a better safety profile than other opioid analgesics. Now that the drug has been deemed a Schedule IV substance, however, health care professionals may be less likely to prescribe it to patients for pain. In 2010 alone, more than 16,000 visits to the emergency room were documented as resulting from the use of tramadol for non-medial purposes.
“As confirmed by the association, current distributors of tramadol are DEA registrants with existing controlled substance storage that complies with DEA regulations,” the agency explained in its declaration. “The DEA understands that handlers of tramadol may need to make modifications to their current security procedures for compliance. These modifications necessary for security compliance will be a 1-time modification to provide for the appropriate storage, revision of operating procedures, training of staff, and amendments to suspicious order monitoring systems to include customer verifications.”
What does this mean for our clients?
At Holladay Pharmacy, we understand the guidelines set forth by the DEA. Our pharmacy in Winston-Salem, NC is designed to handle and store a variety of medications from over the counter drugs to schedule IV controlled substances like tramadol.
However, we also feel it is our duty to assist and guide our customers in the management process of the new controlled medication. Our pharmacists and other team member spent hours helping our customers understand the requirements and assisted in creating new processes to make sure that our customer’s were fully compliant with the new DEA guidelines before August 18, 2014. We feel that this personal touch and desire to serve our customers needs, even when it really isn’t “our problem” is what has made us successful over the years.
If your North Carolina based senior care facility has any questions about how to manage any type of medication, feel free to contact us. We would love to serve you.
By G. Bryan
In December 2013, the Eight Joint National Committee (JNC8) released the latest Evidence Based Guidelines for the Management of High Blood Pressure in Adults.
One of the biggest changes in these updated guidelines is their commended BP goals. For the patient aged 60 years or older (who does NOT have diabetes or chronic kidney disease), the BP goal is now less than 150/90 mm Hg. Patients less than 60 years old OR over 60 years old with diabetes or kidney disease should maintain their BP at less than 140/90 mm Hg.
Another difference is in which classes of medications should be started first for HTN. For the African American population, a thiazide diuretic or calcium channel blocker (CCB) is now recommended as first-line treatment. In The non-African American population, treatment for HTN may be initiated with a thiazide diuretic, CCB, Angiotensin-
Converting Enzyme Inhibitor(ACEI), or Angiotensin Receptor Blocker(ARB).
Please contact your Holladay Consultant Pharmacist for more information.
By D. Newsome
Drug diversion and abuse are huge problems in this country. The“street price” for many prescription drugs is high which incentivizes people to steal them to sell.
Here are some tips to minimize diversion:
- Make sure all“hard” (original,signed paper) copies of prescriptions for controlled substance are sent to the pharmacy. This discourages someone from taking them elsewhere to be filled.
- Ensure all controlled substances are being counted as soon as they arrive into the facility. Don’t leave the count sheet attached to the product. Keep it folded in the narcotic book until you begin to use the product. Someone could take the drugs and the count sheet and you would not know it.
- Return controlled substances as soon as they expire or are discontinued. Holding on to them enables someone to take them before they are written up for return.
- You should receive a completed count sheet for all controls returned to the pharmacy. Reconcile these to the copy of the Medication Return Form you send to the pharmacy and to the copy you receive back from the pharmacy.
Denise Newsome, R.Ph. is the Pharmacy Manager for Holladay Pharmacy.
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