Milicent Malcolm, DNP, GNP-BC, RN, APRN
Prevention of Iatrogenic Suffering in the Elderly: Reducing Inappropriate Prescribing of Medications with an Evidence-Based Knowledge Transfer Project
The issue of inappropriate prescribing to the elderly results in significant morbidity and mortality rates, considerable health care utilization, and may be the source of the rarely discussed phenomenon of iatrogenic suffering. Despite extensive substantiation in the literature to underscore negative consequences of inappropriate prescribing, evidence shows these practices occur commonly. This project consisted of an evidence-based practice knowledge transfer using the Agency for Healthcare Research and Quality Model “A Framework for the Transfer of Patient Safety Research into Practice.” (Nieva et al., 2005) to translate research findings into health care practice for attendees at an advanced practice registered nurse conference. This live, multi-media program emphasized inappropriate use of central nervous system-active medication in the cognitively impaired, concurrent use of cholinesterase inhibitors and anticholinergics with the prescribing cascade often involved in this misuse, and a proactive approach for the prevention of iatrogenic suffering with the development of a Human-to-Human Relationship, as discussed by Travelbee (1971). The study sample of 38 mainly licensed APRNs in the family practice specialty, reported a large percentage of their patient panel as elderly. The program’s effectiveness was illustrated with an improvement of pre-test and post-test knowledge scores from 60.4 to 89.0 (p=.oo), respectively. A high level of commitment to reduce inappropriate prescribing (mean 4.6; 1= no impact on prescribing behavior to 5= strongest impact on prescribing behavior) was expressed by participants. Identification of the participants’ opinions of the impact of known processes leading to inappropriate prescribing showed processes with the highest impact on inappropriate prescribing were: specifics related to prescribing to the elderly are not considered since a “one size fits all” prescribing behavior is employed; there is a deficit in transfer of information between primary care and acute care; and, acute considerations strongly drive prescribing leaving other considerations to be overlooked. Educational efforts, such as this project, are strategies to highlight the evidence of inappropriate prescribing in practice and are important for advanced practice nursing continuing education.
Pictured above (from left to right): Professor Thomas van Hoof, Professor Sandra Bellini, Millicent Malcolm, Professor Patricia Neafsey, and Professor Colleen Delaney