Optimizing Medications:

Building a Puzzle in Fraser

Health Residential Care

Lori Blain BScPhm

Lori.blain@fraserhealth.ca

Gina Gaspard RN CNS

Gina.gaspard@fraserhealth.ca

Meet Mrs. Brown

Admitted to hospital...

• What medication-related initiatives

apply?

• What about when she’s transferred to

the PATH unit?

• What about when she develops a UTI

on the PATH unit?

Moving to residential care...

• What medication-related initiatives

apply upon transfer?

•Residents living out their lives in residential care experience quality living. •Residents and families are included in decision-making to their desired level. •Health care team and physicians feel supported in decision making. •The focus is on the resident and his/her goals of care. •Residents receive quality medical care no matter their age, disease or socioeconomic status.

It is important that…

What we heard: There is not one solution or strategy to solve the concerns of polypharmacy.

• Health human resources

• Continuity of care

• Family care providers

• Communication

• System

Three Key Pieces

Knowledge

Teamwork & System

Nurses

Physicians

Pharmacists Nurse Practitioner

Resident & Family Patient Voices Network

Communicare

Med Rec

CLeAR

BPSD Guideline & Algorithm Palliative

Approach

What about knowledge gap?

Goal

Enhanced safety, quality of life

and quality of medical care

resulting from person centred,

individualized medication use

for adults living in residential

care homes.

What is Polypharmacy?

• Levothyroxine 125 mcg daily

• ASA 81mg daily

• Clopidogrel 75mg daily

• Metoprolol 50mg BID

• Acetaminophen 650mg TID

• Hydromorphone IR 0.5mg daily and 1.0 mg HS

• Diclofenac 5% gel BID to sore areas

• Calcitonin 200units into one nostril BID (she still had some of her own supply)

• Calcium 500mg daily (noon)

• Vitamin D 20,000 weekly

• methylcellulose eye drops 1-2 BID

• PEG 33350 17 gm daily

• Senna HS

• Trazodone 50mg HS

• Zopiclone 7.5mg HS

• Risperidone 0.25mg BID PRN for restlessness

What is Polypharmacy?

More medications than

clinically required or appropriate

Tables

Raising Awareness

http://www.youtube.com/watch?v=P

XoLsW0w1FE&rel=0

• 15 minute power point to

introduce topic to direct care staff

• Letter to nursing, physicians &

pharmacists

• Family/ Resident Brochure

Decision – Making Tools

1. Surprise ?

2. Request for Information Form

3. Medication Indication Form

4. Nursing Assessment Guide

Transferred to Residential Care

How does this impact Mrs. Brown?

Where we are now?

• Draft Protocol with tools

• Raising awareness

through engaging

stakeholders (formal &

informal)

Lessons learned to date

(there will be more lessons)

• Spread the meetings further than 2 weeks

apart to allow adhoc meetings to come to

consensus.

• Identify a captain for each adhoc group.

• We have a NP, director of care and direct

care RN but could use LPN and RCC.

• Face-to-face meetings are important.

Lessons learned (continued)

• It takes an interdisciplinary team to make a

polypharmacy reduction strategy

• All team members need to be heard and

perspectives incorporated.

• It is a process; not a task

Helpful Resources • Shared Care (Mhezbin, Chris & Keith) • American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012). American

Geriatrics Society Updated Beers criteria for potentially inappropriate medication use in older adults. The Journal of the American Geriatrics Society, 60 (4), 616-631. DOI: 10.1111/j.1532-5415.2012.03923.x

• Barry, P., Gallagher, P. Ryan, C., & O’Mahony, D. (2007). START: An evidence-based screening tool to detect prescribing omissions in elderly patients. Age and Ageing, 36 632-638.

• Best Practice Advocacy Centre New Zealand (2010). A Practical Guide to Stopping Medicines in Older People, BPJ, 27 11-23. http://www.bpac.org.nz/BPJ/2010/April/docs/bpj_27_stop_guide_pages_10-23.pdf .

• Garfinkel, D., Zur-Gil S., Ben-Israel J. (2007). The war against polypharmacy: A new cost effective geriatric-palliative approach for improving medication therapy in disabled elderly people. Israel Medical Association Journal, 9 (6), 430-4.

• Gallagher, P., Ryan, C., Byrne, S., Kennedy J., & O’Mahony, D. (2008). STOPP: Consensus validation. International Journal of Clinical Pharmacology and Therapeutics. 46 (2), 76-79.

• Haque, R. (2009). ARMOR: A tool to evaluate polypharmacy in elderly persons. Annals of Long-Term Care, p. 26-30.Path.ca

• Scott, I., Gray, L., Martin, J., Pillans, P., & Mitchell, C. (2013). Deciding when to stop: Towards evidence-based deprescribing of drugs in older populations. Evidence Based Medicine, 18 (4), 121-124.

Next steps • Finish Protocol

• Process indicators

• Education plan

• Implementation plan

• Standardizing format for tools and

uploading into system