1. Optimizing Medications:
Building a Puzzle in Fraser
Health Residential Care
Lori Blain BScPhm
Gina Gaspard RN CNS
2. Meet Mrs. Brown
3. Admitted to hospital...
• What medication-related initiatives
• What about when she’s transferred to
the PATH unit?
• What about when she develops a UTI
on the PATH unit?
4. Moving to residential care...
• What medication-related initiatives
apply upon transfer?
5. It is important that…
•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
•Residents receive quality medical care no matter
their age, disease or socioeconomic status.
6. What we heard: There is not one
solution or strategy to solve the
concerns of polypharmacy.
• Health human
• Continuity of care
• Family care
Enhanced safety, quality of life
and quality of medical care
resulting from person centred,
individualized medication use
for adults living in residential
11. 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
Calcium 500mg daily (noon)
Vitamin D 20,000 weekly
methylcellulose eye drops 1-2 BID
PEG 33350 17 gm daily
Trazodone 50mg HS
Zopiclone 7.5mg HS
Risperidone 0.25mg BID PRN for restlessness
12. What is Polypharmacy?
More medications than
clinically required or appropriate
14. Raising Awareness
• 15 minute power point to
introduce topic to direct care staff
• Letter to nursing, physicians &
• Family/ Resident Brochure
15. Decision – Making Tools
1. Surprise ?
2. Request for
3. Medication Indication
4. Nursing Assessment
16. Transferred to Residential Care
How does this impact Mrs. Brown?
17. Where we are now?
• Draft Protocol with tools
• Raising awareness
stakeholders (formal &
18. Lessons learned to date
(there will be more lessons)
• Spread the meetings further than 2 weeks
apart to allow adhoc meetings to come to
• 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.
19. Lessons learned (continued)
• It takes an interdisciplinary team to make a
polypharmacy reduction strategy
• All team members need to be heard and
• It is a process; not a task
20. 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.15325415.2012.03923.x
Barry, P., Gallagher, P. Ryan, C., & O’Mahony, D. (2007). START: An evidencebased 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 1123. http://www.bpac.org.nz/BPJ/2010/April/docs/bpj_27_stop_guide_pages_1023.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.
Standardizing format for tools and
uploading into system