Did you know that 4% of Medicare patients discharged to skilled nursing facilities (SNFs) after surgery received a new postoperative gabapentinoid prescription? Of those patients, 38% had prolonged use after discharge from the SNF to home. These findings raise important questions about gabapentin use in skilled nursing facilities and what happens after the original need for the medication has passed. Gabapentin is frequently used for nerve pain, such as neuropathy, and can be effective at treating postoperative pain. However, as with any medication, it is not without risk!
Gabapentin can cause common side effects such as dizziness, drowsiness, and swelling. Rare but serious reactions can include allergic responses, mood changes, and breathing problems. Other side effects include tiredness, clumsiness, unsteadiness, vision changes, and mild gastrointestinal issues. If these aren’t already troublesome, some residents may experience depression, anxiety, irritability, agitation, or suicidal thoughts.
According to research highlighted by I.M. Matters from the American College of Physicians, prolonged postoperative gabapentinoid use after SNF discharge may be more common than previously recognized. This makes medication review an important consideration, particularly when residents experience new or unexplained changes.
First, do no harm. Get a report on the number of residents with gabapentin orders and take it to your next QAPI meeting. Compare the information with your fall and incident logs. Are any residents experiencing adverse side effects, such as falls, increased behaviors, or gastrointestinal symptoms?
If even one resident is experiencing a negative outcome that could be related to the medication, consider whether a Performance Improvement Project (PIP) is appropriate. A PIP could focus on reviewing gabapentin use in skilled nursing facilities and identifying residents who may benefit from a medically supervised dose reduction. Remember, gabapentin should not be stopped abruptly because doing so can cause withdrawal symptoms. No drug is without side effects.
Stay well and stay informed!
