Effective Plan to Reduce Polypharmacy in a Long Term Care Facility Essay Paper

Provide a title that conveys or describes the assignment.
Introduction – Provide an introduction to your topic or project. The introduction gives the reader an accurate, concrete understanding what the project will cover and what can be gained from implementation of this project.
Overview of the Problem – Provide a synopsis of the problem and some indication of why the problem is worth exploring or what contribution the proposed project is apt to make to practice.
References – Cite references using APA 7th ed. Manual.  Effective Plan to Reduce Polypharmacy in a Long Term Care Facility Essay Paper

Implementation of a Change Initiative: An Effective Plan to Reduce Polypharmacy in a Long-Term Care Facility

Evidence-based practice (EBP) requires that interventions used on patients be only those supported by evidence from current peer-reviewed scholarly sources (Melnyk & Fineout-Overholt, 2019). In long-term care facilities, older patients undergo care and rehabilitation for the various comorbid conditions and injuries (usually fall injuries) that they have. Because of the very fact that older persons aged 65 years and above in long-term care facilities have multiple co-existing chronic conditions, they usually take upwards of five medications at a given time. This is polypharmacy and is likely to predispose them to dangers such as double dosing with drugs of the same class (duplication), drug interactions, and sensitivity due to reduced efficiency in metabolism (first pass effect). This project aims at reducing the likelihood of the elderly patients in a long-term care facility being exposed to polypharmacy. The interventions that are expected to be implemented and that are evidence-based are a bundle of medication reconciliation during care transition (from home to the long-term care facility), assessment for drug interactions, and removal of duplicated prescriptions (Kim & Parish, 2017). The purpose of this paper is therefore to state the problem (polypharmacy), the population affected, and the potential solution in the change project.


Problem Overview

According to Kim and Parish (2017), about three out of every ten elderly patients currently receive five or more medications at a go because of the multiple chronic conditions that they suffer from. This is the practice that is referred to as polypharmacy. It exposes them to many risks because older persons have physiologic systems that are deteriorating in efficiency as the result of the normal ageing process. This inefficiency in physiology negatively affects the pharmacokinetics of medications administered. When polypharmacy is involved, this risk is magnified many times. For instance, absorption of oral medications from the gut in older patients is compromised because the p-glycoprotein pump involved in transporting medication molecules across the plasma membranes of villi cells are less effective. Also, older persons have less lean body mass and as a result distribution of hydrophilic medications is affected. On metabolism, the first pass metabolism of medications is also affected negatively since the cytochrome P450 pathway becomes less efficient in old age. Effective Plan to Reduce Polypharmacy in a Long Term Care Facility Essay Paper  Lastly, renal excretion is also compromised because renal function is reduced in old age as shown by progressively falling estimated glomerular filtration rate or eGFR (Rosenthal & Burchum, 2018).

Because of the dangers of polypharmacy as discussed above, it is important that all efforts are made to reduce the likelihood of polypharmacy as much as possible. In light of this, the best thing to do would be to use nonpharmacological interventions as much as possible with older patients. Where this is not possible, proper reconciliation of medications during care transition should be done to eliminate the chance of duplicating medications. After that any duplicate medication noted should be removed and the patient monitored closely for drug interactions. The contribution of this change project to practice will be immense. It will enrich the body of knowledge of EBP and will better the patient outcomes for the elderly patients in long-term care facilities.


Polypharmacy is a particularly risky practice in elderly patients undergoing rehabilitation in long-term care facilities. This is because their bodily processes have slowed down and they can no longer handle medications with the same efficiency that they did when they were young. There is therefore need to prevent polypharmacy in this population demographic using evidence-based interventions. This is what this project has proposed in the form of reconciliation of medications during care transition, removal of duplicated prescriptions, and monitoring the patient consistently for drug-to-drug interactions while at the care facility.


Kim, J., & Parish, A.L. (2017). Polypharmacy and medication management in older adults. Nursing Clinics of North America, 52(3), 457–468. https://doi.org/10.1016/j.cnur.2017.04.007

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.

Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.  Effective Plan to Reduce Polypharmacy in a Long Term Care Facility Essay Paper





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