Q: I suspect the nursing home is overmedicating my elderly mother. She is lethargic and practically comatose when I visit. How can I find out what's going on?
A: There are numerous options that are available for you to do to address this serious situation. I recommend when anyone finds a loved one in such condition that you immediately address such health status in all of the following ways.
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Immediately ask for the nursing station supervisor and inquire as to any changes your mother may have undergone in the last 24 hours. Accept explanation of these changes only if documented in your mother's clinical record, her chart.
Regardless of the explanation, immediately address your mother's condition with the Nursing Director and Administrator. If it is the week-end, address it with the house supervisor and follow up with the Nursing Director and Facility Administrator Monday morning. You can request that in the future such health status be reported to you or others in your family as part of the overall plan of care for your mother.
While you are speaking to the various individuals, always keep a documentation log. Ask for a report/copy of the medications that have been administrated in the past 48 hours. Verify if new mediations were started, and if an "as needed" medication have been given. If so, ask what was the documented reason as to why each "as needed" medication was given.
Verify the amount of fluid that is being consumed, the amount of food consumed, any changes noted by staff, nursing or other departments, (changes in mobility, distance walked, voiding, or falls, possible physical interaction with another patient).
I would also address these issues with your mother's physician and if needed the facility's Medical Director who is responsible for the overall care provided within the facility. You are encouraged to ask that the facility's consultant pharmacist to evaluate the overall use of all of her routine and as needed medications. You mother's condition could be a progressive decline in health or elimination of her meds. She may need some of her medication reduced.
She may have been given an "as needed" medication which may have caused more sedation that expected and any future "as needed" dosage should be adjusted to a smaller dosage.
Regretfully, she may have also been given medication(s) to control behaviors without a redirection being attempted. Redirection is a non-drug intervention such as removing her from an agitating environment, repositioning her, removing the "irritation". This redirection, non-drug intervention should be documented in some part of her chart. Staff should document such interventions to change behavior prior to the use of certain medications.
Depending on the results that you find, you may need to consider addressing your mother's condition with the regulatory body for nursing facilities in your state.
Lynn Harrelson is a pharmacist who specializes in medication and prescription management for seniors.
Read her full biography