An herbal primer for your agency
What’s moved into your patients’ medicine chests?
When the Irondale, AL-based home care agency Alacare installed a new computer system, it turned up an unexpected problem.
"We put in the new drug database, and all of a sudden I got a lot of nurses calling me to say there was no listing for Kava-Kava," recalls DeAnna Minard, RPH, the agency’s pharmacy director.
Kava-Kava is an herb (for more on popular herbs and their uses, see box on p. 78), and Minard noted there was no code number for this class of medication. That meant that neither it nor any other herb was in the off-the-shelf drug databases. At the same time, news about herbals was increasing, and Minard’s professional associations started encouraging members to educate themselves on these issues.
The confluence of occurrences led Minard to create a series of inservice designed to help Alacare’s nurses understand herbals and their uses. They, in turn, would be better able to assist patients who choose to use these — either as an alternative to more traditional drugs or in conjunction with them.
"If a patient complains of having red urine and you find no blood and nothing in their medications, you need to know that horse chestnut seed extract — a common treatment for hemorrhoids — might cause that effect," says Minard.
Herbal remedies are becoming so common that you can find well-known vitamin brands like One-A-Day including them in supplement preparations. You can even find teas and foods that have herbs such as ginkgo or St. John’s wort added to them.
Lorraine Waters, MA, BSN, C, CHCE, director of Southern Home Care in Jeffersonville, IN, says her agency is also gearing up to deal with this issue.
"We have gathered articles, and I have distributed a newsletter on various drug-herb interactions," she says. Southern Home Care has also ordered a copy of the new Physician’s Desk Reference for herbal medicines, which includes some 600 monographs on herbs. (For more reading and information sources, see box, p. 79.)
She plans to have staff record herbals in the patient medication record and provide education to patients on side effects and danger signs to patients. Unfortunately, Waters doesn’t think that she can add information on the herbs to her existing electronic drug portfolio.
Minard says before she started providing education, she had to decide what nurses needed to at inservices. "We wanted it to be practical and geared towards taking care of patients," she says. "When we started, we included things like medicinal chemistry, mechanisms of action, and pathways."
That wasn’t popular with staff.
"Our evaluations were less than good," she admits. "We revamped, spending more time talking about the results of studies and the things that some of these drugs can do."
Part of the inservice seminars also focuses on how to get information out to the patients about herbals, and how to deal with patients who might not be forthcoming about all the preparations they are taking.
"A lot of patients don’t recognize that these herbs are medicines," says Minard. Still, others might be embarrassed about taking something like St. John’s wort for depression. Yet knowing this can be vital. If a patient is taking another drug for depression, such as Prozac, mixing in an herbal remedy can have serious consequences.
"When nurses do the initial assessment, they have to often look through all the meds, and so that is one way they find out," she says. The nurses seem to have a way of teasing information from otherwise recalcitrant patients.
Waters says that getting this information from patients is something of an art. "I think it depends in part on the interviewer," she says. "Tact is a very useful tool. But remembering to ask can be a problem. Perhaps we should all take our ginkgo biloba!"
Once they know what a patient is taking, nurses at Alacare include information on any herbal preparations as part of the medication profile and forward it to the primary care physician.
Minard says she is still finding a lot of gaps in knowledge about herbs among physicians, and that she has to do some educating, as well. "Some are sending their nurses to seminars on herbals," she says, "but they don’t go themselves."
One thing that Minard learned as she prepared for the inservices is that you have to be careful about the sources of information you use to educate yourselves.
"A lot of the manufacturers and sellers over the Internet may have information, and it may be legitimate. But if they start telling you how to buy it, then instantly, you should question the validity."
Updates to her educational material are probably inevitable, says Minard, as more information about existing herbal remedies emerges, and as new herbal preparations are released. "But we will probably do a lot of communication through e-mail or newsletter formats."
Patients are much more educated about herbal medicines than you may think, says Minard. "They have read up on this, but you can’t always be sure about the quality of the information they get. They may be getting something from their neighbor or sister-in-law, and that might not be appropriate. Or it might come without any information at all. And if our patients are out there using this stuff, then we have to be ever mindful of it. We have to know at least as much as they do."
Sources
• Lorraine Waters, MA, BSN, C, CHCE, Director, Southern Home Care, 1806 E. 10th St., Jeffersonville, IN 47130. Telephone: (812) 283-2602.
• DeAnna Minard, RPH, Director of Pharmacy, Alacare, 2300 Crestwood Blvd., Irondale, AL 35210. Telephone: (205) 981-8556.
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