A variety of initiatives and approaches are being used to help achieve the goals of the project. To learn more about the Medication Management Project, click here.

To help improve medication use in long-term care, the Medication Management Project advisory committee has planned a variety of initiatives. The first of these is a focus on the top ten drug interactions involving long-term care residents. If these ten drug interactions can be prevented or managed, the committee believes that a significant impact can be achieved in improving quality of care provided to these residents.

List of Top Ten Dangerous Drug Interactions in Long-Term Care
Medications chosen for the Top Ten list were based on their frequency of use in older adults in the long-term care setting, and on the potential for adverse consequences if used together. Due to individual variability, not every older adult who takes these medications together will experience an adverse reaction. However, these combinations have the potential to produce harmful effects.
The purpose of this Top Ten list is to alert the interdisciplinary team to the possibility that a negative interaction may occur, so that steps may be taken to choose alternative medications, adjust doses, monitor the patient carefully, or take other such actions as may be appropriate.

Click on the drug interaction of interest to see more details.

1. Warfarin — NSAIDs*
2. Warfarin — Sulfa drugs
3. Warfarin — Macrolides
4. Warfarin — Quinolones**
5. Warfarin — Phenytoin
6. ACE inhibitors — Potassium supplements
7. ACE inhibitors — Spironolactone
8. Digoxin — Amiodarone
9. Digoxin — Verapamil
10. Theophylline — Quinolones**

* NSAID class does not include COX-2 inhibitors
** Quinolones that interact include: ciprofloxacin, enoxacin, norfloxacin, and ofloxacin

Future Initiatives
The advisory committee has met and discussed a number of ideas for additional focus areas to improve medication management in long-term care. For each focus area, a variety of resources and tools will be developed to help medical directors and consultant pharmacists work together to improve medication use in their facilities.

Future areas of emphasis will include:

• Warfarin use
• Monitoring and reporting of adverse drug reactions
• Delirium
• Pain

Another planned element is the development of an information kit on "Medication Management in Long-Term Care", including guidelines for practitioners and team members regarding identification of adverse drug reactions and suggested reporting systems and strategies for response.

The Multidisciplinary Medication Management Project is supported, in part, by an unrestricted educational grant from GlaxoSmithKline.