Articles Posted in Prescription Medication Misuse

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The antibiotic is considered one of the greatest achievements in the history of mankind.  However, scientist have been studying antibiotic resistance since the 1940’s.  In 1947, penicillin became ineffective against its first bacterium.  Unfortunately, only as recent as 2017 have nursing homes been forced to develop, implement, and maintain an antibiotic stewardship program.

An Overview of the Problem

In any long-term care facility, the spread of bacteria and viruses is all but inevitable.  Mitigation techniques such as hand washing, frequent bathing, linen changes, and contact precautions do help, but at some point, this is not enough.  Increasingly, nursing home residents are being prescribed antibiotics even when their indications do not meet the criteria.  You may be surprised to know that, according to the CDC, 50%-70% of nursing home residents are prescribed antibiotics in any rolling 12-month period.  Additionally,

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It is nearly impossible to avoid any medication error at a nursing home, meaning every individual establishment is required by state inspectors to keep their error rate below 5 percent. This mandate only includes minor errors, with essentially no acceptance of major medical incompetence. However, even with these regulations in place, nursing homes are not infallible.

What Constitutes a Medication Error?

There are many different forms of medication malpractice ranging from minor mistakes with little to no consequence, all the way to life threatening errors. These are some of the most common errors:

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Nursing homes are often under-staffed in an effort to maximize profits or because they are underfunded.  With the number of elderly people requiring care increasing at a record pace, some institutions use prescription drugs to make their residents more “manageable”.  Legal and ethical issues notwithstanding, the health implications of the use of chemical restraints are terrifying.

What Is a Chemical Restraint?

Put simply, a chemical restraint is when someone’s movement or actions are restricted through pharmaceutical intervention.  Types of drugs used as chemical restraints are:

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Elder abuse in any form is strictly prohibited by California law. In addition to physical abuse and neglect, medication errors in nursing homes are considered a form of elder abuse. Unfortunately, due to insufficient staffing in many long-term nursing facilities, errors in the type and amount of medications administered to residents occur with alarming frequency. While in many cases there may be no detrimental side effects to an elder who is given the incorrect medication, or the wrong dosage; in many other cases, the error can prove fatal.

For example, if two patients’ medications are mixed up, and incorrectly administered, the outcome can be disastrous. A diabetic who is mistakenly given a fellow patients’ heart medication may not under normal circumstances have a negative reaction. However, if that heart medication happens interacts with other medications he or she is taking, or causes side effects that the patient can’t sustain; the mistake can result in death.

Other medications must be taken consistently in order for them to be effective. Therefore, missing a dose of the proper medication can have devastating consequences on the elder who has missed their dosage. Other medication errors that may occur in nursing homes include:

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The use of physical and chemical restraints in California nursing homes is sometimes a necessary way of protecting patients from injuring themselves and others. When used excessively and, more importantly, without consent, the practice becomes outright abusive. Often this method is used not simply to protect the patient, but rather to make a staff member’s job easier. Overuse of restraints is exacerbated by the growing number of understaffed nursing facilities.

Physical restraints are used to keep patients from wandering around the facility, a potential hazard for the patient and others. A nursing home is required by law to have the resident’s consent before using a physical restraint. Symptoms of physical restraints include sores or bruising on the arms and legs, usually on the ankles and wrists.

Chemical restraints involve the administering of powerful psychotropic drugs to sedate and confine the patient by taking away his or her cognitive abilities. These drugs are not permitted under any circumstances unless the nursing care facility outlines a legitimate medical reason for their use and further provides the frequency and dosage. Because most people are not familiar with the side effects of psychotropic drugs, it can be more difficult to identify chemical restraints than physical restraints.

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It is an unfortunate fact that elder abuse is a common and growing problem in San Diego and throughout the United States. Abuse of the elderly can take many forms, ranging from neglect and abandonment to physical, verbal, financial, and even sexual abuse. Fortunately, professionals in health care are constantly working towards new breakthroughs in treatment and the prevention of abuse in the elderly population. It’s true that new research and techniques are changing the face of convalescent care every day.

As the population of elders in San Diego continues to grow, it’s also encouraging to see the elder abuse epidemic be drawn out of the shadows and into the light, so we can all learn to recognize symptoms of elder abuse, and report any suspicions. One such example of shining a light on elder abuse prevention will be coming to Southern California next month.

On September 15, 2016 the 2-day USC Judith D. Tamkin International Symposium on Elder Abuse will welcome “researchers, academics, physicians, nurses, and psychologists” to participate in a weekend committed to “Closing the Research Gaps and Moving the Field of Elder Abuse Forward.”

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Each year, more than one in three seniors sustain falls, which result in serious injuries. In some instances, falls are the result of elder or nursing home abuse. But in other instances, falls are purely accidental. An experienced San Diego attorney specializing in elder abuse or nursing home abuse, to include neglect, can help you distinguish if an injury from a fall was an accident or caused by the negligence or wrongdoing of another.

As we age, the likelihood of being diagnosed with a medical condition or disorder requiring prescription medication(s) is almost guaranteed. Because of this, far too many elders run the risk of being over-medicated, or experiencing dangerous side effects which increases the risk that an elder may fall. Many seniors are prescribed medications that have dangerous interactions when taken in conjunction with other medications.

To reduce the risk of experiencing potentially dangerous prescription interactions, it is recommended that seniors use caution when taking prescriptions or even over-the-counter (OTC) medications.

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Society erroneously assumes prescription medication is only abused by the younger generations. Studies show, however, prescription drug abuse plagues men and women of all ages, including the elderly.

According to an article in the National Institute on Drug Abuse, “Persons aged 65 years and older comprise only 13 percent of the population, yet account for more than one-third of total outpatient spending on prescription medications in the United States.” The article goes on to suggest that there are several ways in which an elderly person can abuse prescribed medication, such as:

• Abusing medication prescribed to a friend or family member in order to save money.
• Alternatively, the elder person has his/her medication taken by a friend or family member and running out of his/her supply early.
• Taking the incorrect dosage or type of medication to do mental decline.

Awareness is everyone’s responsibility, so be vigilant. There are cues that family, friends, and caregivers can recognize in order to intervene and get help as early as possible.

What should we be looking for?

• A loved one is showing signs of an unhealthy relationship with their medication, such as:

– Frequently talking about medicine

– A fear of running out or not having enough medication

– Taking a defensive stance after you ask about the medication

– Taking more than the prescribed amount or taking more often than prescribed

– Hiding or hoarding pills

• A loved one’s behavior and mood is changing, even if it seems associated with “old age” or illness. This could be a sign of chemical dependency.

• A past history of drug/alcohol abuse can make a person more susceptible.

If you suspect a loved one is abusing prescription medication, take action and talk to someone about it. A good first step is to contact the doctor prescribing the medication. He or she can help verify and/or validate your concerns, allowing you to take further action, if necessary.
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An investigation by ABC 10 in Sacramento has unveiled that powerful tranquilizers are being over prescribed to nursing home residents who are diagnosed with dementia. In fact, studies by the Centers for Medicare and Medicaid Services in conjunction with the Government Accountability Office (GAO) show that 33% of elders in nursing homes, who are diagnosed with dementia are actually prescribed antipsychotic medication, in spite of the fact that the FDA has warned that certain types of these drugs can prove fatal to elders. Death is most often the result of heart failure/cardiac disorders.

All the same, the data from those studies shows that these powerful drugs are far too often prescribed when they are not warranted. This practice, known as chemical restraint, or over-drugging of elders in nursing homes in California is a form of abuse, and is illegal.
Chemical restraining of elders is most often done to sedate residents, but in worst cases has been utilized as a means of punishing and/or intentionally abusing elders.

Symptoms that an elder is being over-drugged, or prescribed an anti-psychotic inside a California nursing home include:

*Extreme lethargy, sleepiness, and/or confusion.

*Noticeable and extreme behavioral changes.

*Sudden unexplained changes in overall health.

Elder abuse in California is both a criminal and civil offense. Criminal elder abuse describes the willful infliction of physical or emotional suffering on an elder. Civil elder abuse includes any physical or financial abuse, neglect, or abandonment resulting in physical or mental harm.
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According to the Centers for Medicare & Medicaid’s Open Payments Website:

“Sometimes, doctors and hospitals have financial relationships with health care manufacturing companies. These relationships can include money for research activities, gifts, speaking fees, meals, or travel. The Affordable Care Act requires CMS to collect information from applicable manufacturers and group purchasing organizations (GPOs) in order to report information about their financial relationships with physicians and hospitals. Open Payments is the federally run program that collects the information about these financial relationships and makes it available to you.”

In other words, if you’ve ever wondered whether or not a physician caring for your loved elder is the recipient of payments from a specific type of medical device, or a specific medication, you can now research that information online through the Open Payment website.

In addition to the Open Payments website, ProPublica, a non-profit newsroom has created Dollars for Docs (which incidentally shows that 3 of the top 20 highest paid physicians are based in San Diego.)

Consumer advocates who fought for such public disclosures had argued that physicians’ relationships with various drug companies affected their prescribing practices. If you’re interested to find out what payments your physician or a physician caring for a loved elder in California has received from various companies, you may search for this data by clicking here.
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