Online-only content for "Monitoring Medication Use in Older Adults," by Sheila L. Molony, PhD, RN, GNP-BC, in the American Journal of Nursing, January 2009, p. 68-78.


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W(e) Whole person. Consider the person's health, function, and goals and collaborate with the pharmacist and all health care providers to optimize the medication regimen and minimize polypharmacy.


U(se) Undertreatment. Are preventable conditions being addressed?


A Adherence. Does the person know and agree with the goals of medication therapy? Is medicine affordable? Are there potential barriers to proper use (vision, memory, lifestyle, physical function)?


S Safety. Does this medication have a narrow therapeutic range or high incidence of adverse effects? Are there safer alternatives? Do the benefits outweigh the risks? Is there high risk for adverse drug effects because of low creatinine clearance, low body mass index, prior adverse drug effects, or multiple medications or illnesses?


I Interactions. Consider drugs, diseases, alcohol, and food.


M Monitoring. What lab values should be assessed and how often? Consider whether monitoring is needed to detect adverse drug effects.


P Purpose. Is the indication for the medication known and documented? Is there evidence of efficacy? Is the medication achieving the therapeutic goal or goals?


L List. Does the person have an up-to-date, comprehensive medication list that includes herbal and other supplements, vitamins, topical preparations, eyedrops, and over-the-counter preparations used for common conditions?


E Educate. Does the person know the brand and generic names of each medication? Why she or he is taking it? When to call the clinician? Potential interactions? Safety precautions (for example, not suddenly discontinuing the drug, not driving while taking it)?


D Dose. Is the dose too high or too low? Consider renal function, body mass, age, individual response, and laboratory results.


O Optimize nondrug treatment and provide self-care information.


S Simplify regimen, if possible. Consider reducing dosing frequency, using combination products, etc. Consider whether one medication is being used to treat the adverse effects of another medication.


E Efficacy. Periodically reassess whether therapy is effective and appropriate in light of the person's current or changing condition.