A3 · Too many medicines
Risk Older adult
Definition
Many medicines at once raise the chance of interactions and side effects.- Many conditions
- multiple doctors
- no medicine review
- Side effects
- confusion
- falls
- interactions
📋 Scenario
An older woman takes twelve medicines prescribed by four different doctors.
Subjective (S): "I take lots of pills and I do not know why."
Objective (O): 12 medicines; 4 prescribers; no recent medicine review; keeps old tablets at home; no side effects reported yet.
Assessment tools for this scenario: CP-OLDER Older Adult Check
Validated scales to consider: 4AT / CAM, Mini-Cog
**CarePath diagnosis:** Too many medicines related to many medicines and several prescribers (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Review the list. | Going through every medicine shows what is taken, why, and whether each is still needed, which is the first step in finding interactions or unnecessary drugs. |
| Involve a pharmacist. | Pharmacists are experts in interactions and side effects and can advise prescribers on safer combinations and doses. |
| Ask the prescriber or pharmacist to remove duplicate medicines. | Only the prescriber can stop or change medicines; the nurse makes sure the review happens and records the changes. |
| Teach. | When she knows what each medicine is for and how to take it, she is more likely to take them correctly and report side effects early. |
**Expected outcomes**
- Medicine list reviewed.
- Unnecessary medicines stopped only by the prescriber after review.
- No adverse effects.
- Patient names main medicines.
**Linking the data to the diagnosis**
The patient says, 'I take lots of pills and I do not know why.' She takes 12 medicines from 4 prescribers, has had no recent medicine review and keeps old tablets at home. No side effects have been reported yet, so harm has not occurred. For this reason a risk statement fits, and it rests on the number of medicines and prescribers. The plan aims to review the list, stop unnecessary drugs through the prescribers, avoid adverse effects and help her name her main medicines.
CarePath diagnosis
Too many medicines related to many medicines and several prescribers (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Review the list. | Going through every medicine shows what is taken, why, and whether each is still needed, which is the first step in finding interactions or unnecessary drugs. |
| 2. Involve a pharmacist. | Pharmacists are experts in interactions and side effects and can advise prescribers on safer combinations and doses. |
| 3. Ask the prescriber or pharmacist to remove duplicate medicines. | Only the prescriber can stop or change medicines; the nurse makes sure the review happens and records the changes. |
| 4. Teach. | When she knows what each medicine is for and how to take it, she is more likely to take them correctly and report side effects early. |
Expected outcomes
- Medicine list reviewed.
- Unnecessary medicines stopped only by the prescriber after review.
- No adverse effects.
- Patient names main medicines.
Linking the data to the diagnosis
The patient says, 'I take lots of pills and I do not know why.' She takes 12 medicines from 4 prescribers, has had no recent medicine review and keeps old tablets at home. No side effects have been reported yet, so harm has not occurred. For this reason a risk statement fits, and it rests on the number of medicines and prescribers. The plan aims to review the list, stop unnecessary drugs through the prescribers, avoid adverse effects and help her name her main medicines.