While the recommendations in this guide are intended to improve health and safety during the COVID-19 pandemic, there is always a danger of unintended consequences.
| Potential Unintended Consequences | Mitigation Strategies |
|---|---|
| Long-term failure to restart useful medications that were temporarily discontinued, and for which long-term use remains indicated. | Keep a list of all medications that are discontinued and involve the consulting pharmacist in this process. Schedule a meeting time with your pharmacist, medical director, and director of nursing in 8 weeks to re-evaluate all medications on the discontinued list. |
| Return of symptoms and/or other markers of disease activity, which may result in worsening health and additional care needs. | For each discontinued medication, make note of potential symptoms to monitor. Assess for those symptoms, and document with COVID- 19 symptom assessments. |
| Potential resident and care partner perceptions of abandonment and reduced quality of care. | Assure them of steps being taken to monitor and encourage them to let you know if they have concerns or are noticing any changes in symptom control. See section on “Communication Around Medication Changes” for additional suggestions. |
| Social isolation and fewer opportunities for evaluation as a result of less contact with staff. | In care planning meetings, assess and address impacts of changes in medication-related interactions with nursing staff, for example impacts on hydration, loneliness. Note that additional assessments to monitor for early symptoms of COVID-19 infection may balance out the decrease in time spent in distributing medications. |
| Increased costs if less expensive medications are replaced with more expensive medications. | Work with dispensing pharmacy to identify formulary/cost issues. |
| Potential legal or survey consequences if adverse outcomes are attributed to medication management changes. | Document your rationale for making the medication changes and the monitoring that you are doing to keep residents safe. |
It may be wise to adapt or defer medication-related changes if potential harms are likely to exceed the benefits of these changes.