1. Garfield, Sheila RN

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"Reducing the Use of Potentially Inappropriate Medications in Older Adults" (Cultivating Quality, January) highlights an important patient safety measure. However, it doesn't address patient education or assessment of the patient's understanding of her or his drug regimen.

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I work as a visiting nurse to a large population of homebound elderly patients. During each visit, I review the patient's medication regimen and her or his ability to take the medicine as ordered. I've found that patients are often discharged from short-stay rehabilitation facilities and hospitals with inadequate medication information. For example, the patient may be given a generic version of a medication that's only identified by its brand name in the discharge information. These documents may also include illegible medication instructions; directions about "bid," "tid," and "qd," which patients may not understand; and small print and complex instructions, which are particularly challenging for those with visual or cognitive impairment. In many instances, it's the visiting nurse who discovers that the patient isn't taking the medication properly.


More research and awareness are needed to reduce the use of inappropriate medications and to provide education to the elderly population.


Sheila Garfield, RN


Sagamore Beach, MA