MDS Alert

Published on Thu Jun 12, 2008 PDF

When a resident has a decub, it may be time to do a med review.

If you don't consider medications as having the potential to worsen or stall a pressure ulcer, watch out.

Surveyors may be on your case if you haven't taken into account this often overlooked risk factor.

Primary example: Cortico- steroids used to treat respiratory problems, arthritis or other inflammatory conditions. "These meds can suppress the body's immune response and lead to slow wound healing," says Carla Saxton McSpadden, RPh, CGP, assistant director of policy and advocacy at the American Society of Consultant Pharmacists. Cortisone also thins the skin over time and makes it more susceptible to tears, adds Steven Levenson, MD, a medical director in Baltimore. Other medications that can cause problems include:

• Anticholinergic medications, which include some of the older antihistamines, tricyclic antidepressants and many GI drugs, Levenson says. These drugs can cause confusion, poor appetite and dry skin -- all of which are risk factors for skin breakdown, he cautions.

• Medications that worsen or cause urinary incontinence or cause diarrhea. Diuretics can cause excessive urination -- and antibiotics, diarrhea, says McSpadden. "In addition to the excessive urination caused by diuretics, that class of medications can also contribute to dehydration in some situations," which is also a risk factor for pressure ulcers. Thus, residents taking diuretics should be monitored closely, she adds.

• Sedatives/hypnotics and other psychotropic medications. These can sometimes cause excessive sleepiness or sedation, leading to inactivity and a higher risk for developing or worsening pressure ulcers.

Before prescribing: The clinician should consider the aforementioned medications and others known to cause or contribute to sedation, incontinence or a weakened immune response, advises McSpadden. In addition, a focused medication review by the consultant pharmacist may benefit a resident whose pressure ulcers have progressed despite treatment, she says.

Also: Nursing facilities should pay very close attention to the revised F329 (unnecessary medications) survey guidance for all clinical care, Levenson emphasizes.