Medications should always be evaluated when considering a possible cause for a change in behaviors or a decline in functional or cognitive status. Medication should be assessed on a three-point scale (appropriate, marginally appropriate, inappropriate) in 10 domains: indication, effectiveness, dosage, directions, drug with drug interactions, drug with disease interactions, expense, practicality, duplication, and duration.
A chart audit should include:
•Newly prescribed medication.
•Recently discontinued medication.
•An increase or decrease in dosage.
•Any medication that is being refused.
•Medications that could have toxic levels (such as digoxin and lithium).
•Medications that should be monitored by therapeutic lab values.
•Thyroid medication.
•Diabetic agents.
•Iron and other vitamins.
•Blood thinners.
•Diuretics.
•Current medications against a hospital discharge or previous/current home list.
•Pain management medications (narcotic and non-narcotic). Too little pain control limits function, mobility, and motivation. Too much pain medication causes increased drowsiness, confusion, GI disturbances and constipation, and increased risk for falls and behaviors.
•Atypical anti-psychotic drug usage (Risperdal, Seroquel, Zyprexa). The first line of treatment must be looking at behavioral factors such as changes in daily routine or feeling rushed or crowded. Side effects include sedation, increased confusion, and Parkinson like symptoms.
•Anti-anxiety agents.