The Pieces of the Puzzle in Optimizing Medications: 48/6
Linkage to 48/6 CCM
January 16, 2014
David Thompson, VP
Seniors Care & Clinical Support Services
Co-Chair, Provincial Seniors Hospital Care
Objectives of Presentation
• Some History on 48/6.
• Overview of Seniors Hospital Care Working
• Linkage of 48/6 to Other Initiatives
• Implementation Overview
Why Focus On Seniors Care in
• Majority of acute care discharges are seniors.
• 60% of all inpatient bed days.
• 83% of total ALC cases.
• 69% of admissions through the ED.
• Improving outcomes for seniors increases system capacity for
• Initial focus was on five areas in first 48 hours of admission:
• Appropriate Medication Use
• Functional Mobility
• Nutrition/ Hydration
Provincial Seniors Hospital Care
• Formed in 2011 as a working group under the Health
Operations Committee (HOC).
• Representatives from each health authority and
Ministry of Health.
• Co-Chaired by a health authority representative and
• Focus on improving hospital care for seniors.
SHCWG Areas of Focus and
Areas of Focus:
• Integration, Education, Communication
Going home better, note worse.
Delivery of strong, basic clinical care.
Develop an enabling environment.
Promote independence upon discharge.
Longitudinal care management.
• Engagement with BC Patient Safety & Quality
• Shared experiences of work happening related to
seniors care in hospital.
• Understanding linkages to other priorities of the
• Completion of Annual Work plan Priorities
What is 48/6?
Seniors in Hospital Care (48/6)
• Prevent disability and deterioration of seniors in
• 48/6 refers to six guideline screenings that are to
be completed within 48 hours of admission.
1. Functional Mobility
2. Nutrition and Hydration
3. Bowel and Bladder Control
4. Medication Management
5. Cognition: Delirium/ Dementia
(prevention, detection, and management)
6. Pain Management
• SHCWG view that 48/6 is different from other
• Requires a culture change and significant
• 48/6 is about good screening, assessment and care
planning to improve patient outcomes.
• Ministry of Health launched 48/6 CCM in October
48/6 Process Steps
1. An initial assessment of presenting complaint is
completed using a standardized approach.
2. Within first 48 hours of admission, assessment of all
48/6 modalities is completed with direct input from
multidisciplinary team members.
3. Patient specific care plan is written with
4. Care Plan reviewed and updated daily based on changing
Link to Seniors Action Plan
• Ministry of Health launched Seniors Action Plan
with clear deliverables and time-lines.
• 48/6 supports the Seniors Action Plan related to
creation of standardized guidelines for care of
seniors in hospital.
Can significantly improve care for seniors in hospital.
Focus good screening, assessment and care planning.
Dove-tails with some significant information system
enhancements within HA’s.
Opportunity to work collaboratively to improve seniors
Opportunity to standardize processes of care to create a
consistent patient experience.