Читать книгу The Advanced Practice Registered Nurse as a Prescriber - Группа авторов - Страница 24

APRNs continually gain experience and knowledge of the constantly changing area of pharmacological treatment. Rational prescribing is a method of drug management that is well established in international health and has become a cornerstone for prescribing medications to avoid adverse drug events (ADEs). The World Health Organization (2002) defined the rational use of medicines as follows:

Patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and the lowest cost to them and their community.

The risk factors for ADEs are patient‐related, drug‐specific, and clinician‐specific. Older adults and children are both more vulnerable to an ADE; however, polypharmacy, the strongest risk factor for an ADE, is more common in adults. Four types of medications – antidiabetic drugs, oral anticoagulants, antiplatelet agents, and opioid pain medication – account for more than 50% of emergency department visits for ADEs in Medicare patients (Agency for Healthcare Research and Quality, 2020).

Some medications may not be appropriate for specific populations. The Beers Criteria and Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) can be used in a complementary manner to evaluate potentially inappropriate medications for adults 65 years or older (Blanco‐Reina et al., 2014). The Beers Criteria identify medications that should be avoided because they are ineffective, they pose an unnecessarily high risk, or there is a safer alternative. The criteria also identify medications that should not be prescribed when the person has specific health problems. The STOPP criteria are organized according to physiological systems and overcome some of the limitations of the Beers Criteria.

Rational prescribing also involves prescription drug costs. One way to reduce costs without compromising high‐quality care is the use of generic drugs. Brand‐name drugs are usually prescribed for patients who have a strong preference or when generics fail or are not available. Safety of brand‐name drugs can also be an issue particularly when a medication is new to the market. There is less information about potential adverse consequences that may become apparent only after years of widespread use. Box 2.1 presents some strategies for improving rational prescribing.

Many professional organizations publish clinical guidelines and standards of care that include strategies for prescribing. All APRNs, especially novice practitioners, can benefit from these and other resources. A key aspect of rational prescribing is documentation of decisions. Refer to Chapter 8 for a full discussion on the importance of documentation.