MEDICATION CARE PLANNING
Keith White
Clinical Lead, Medication Reconciliation
Chris Rauscher
Clinical Lead, Seniors Care
Patient
Community
-PAD
-PPh-2014/15
TiC

Residential Care
-MedRec
-PPh
-CLeAR

Hospital
-MedRec
- 48-6
-PPh

MedRec=Medica...
Med-Related InitiativesCommonalities
• Purpose: Patients/Residents
– Quality of life and safety, overall management,
not j...
Medication-Related Initiatives
• BCPSQC
– Clinical Care Management
• MedRec
• 48-6

– CLeAR

• MOH / BCMA Shared Care Comm...
Medication-Related Initiatives
• Most are relatively new initiatives so need
to bring together at initiative and local
pra...
Medication Reconciliation
in Residential Care
• Medication Reconciliation in long--term care is a
formal process of:
•

At...
Medication Reconciliation…
• Is the foundation for:
– more accurate medication review
• Q6month reviews (physician, nursin...
Shared Care Polypharmacy
• “Medication Review” is the basic
technology
• “De-prescribing” but can also be for
prescribing,...
Shared Care Polypharmacy
• Phase 1-Prototyping 8 care facilities in BC
• Phase 1A (2013/2014)- Expand care
facilities
• Ph...
Shared Care Polypharmacy
RC Med Reviews Opportunities
•

Occasions for Full RC Medication Reviews
– Scheduled Med Reviews – regular, but
effective?...
Priority Drug List
Drugs associated with:
• Confusional States
– antipsychotics, antidepressants, opioid analgesics,
hypno...
Supports For Drug Review
Decisions
• Guide individualized consideration of patient-at-hand
– Drug Advisory Sheets [drafts]...
48-6 in Acute Care
• Hospitalized seniors (aged 70 and older)
• Integrated care initiative which addresses
six care areas ...
48-6 in Acute Care
• To reconcile all medications on admission
and at discharge and to limit risk for
medication reconcili...
Transitions in Care
• Shared Care Committee-Physicians + Health
Authority initiatives
• Reduce re-admissions
• Communicati...
PAD
•
•
•
•

Provincial Academic Detailing
Ministry of Health- Pharmaceutical Services
In depth drug information in GP off...
CLeAR
• Main focus BPSD and antipsychotic
medications but take a holistic view of the
resident
• Assessment, care plan wit...
Patient
Community
-PAD
-PPh-2014/15
TiC

Residential Care
-MedRec
-PPh
-CLeAR

Hospital
-Med Rec
- 48-6
-PPh

MedRec=Medic...
Bringing Med-Related Initiatives
Together-Care Scenario
• Mrs. Brown is an 86 year old widowed
woman, with a moderately se...
Care Scenario
• A few months later, Mrs. Brown is not eating well
and she appears to be more confused. She has a
fall and ...
Care Scenario
• The Risperidone was stopped after a few
days in the care facility as it was thought that
the agitation was...
General Discussion
How Can We Promote the
Integration of the Various MedRelated Initiatives?
Polypharmacy Contact
information
• Website
– www.bcma.org/polypharmacy-initiative

• Contacts: Keith White, Physician Lead...
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Medication Care Planning: CLeAR Kick-Off Event

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This presentation was delivered at the kick-off event for CLeAR on October 9, 2013 by Keith White, the BC Patient Safety & Quality Council's clinical lead, medication reconciliation, as well as Chris Rauscher, the BCPSQC's clinical lead, seniors care.

The aim of CLeAR – our Call for Less Antipsychotics in Residential Care – is to achieve a reduction in the number of seniors in residential care on antipsychotic medications by 50% across BC by December 31, 2014 through a province-wide, voluntary initiative that supports participating sites.

Learn more at www.CLeARBC.ca.

Published in: Health & Medicine
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Medication Care Planning: CLeAR Kick-Off Event

  1. 1. MEDICATION CARE PLANNING Keith White Clinical Lead, Medication Reconciliation Chris Rauscher Clinical Lead, Seniors Care
  2. 2. Patient Community -PAD -PPh-2014/15 TiC Residential Care -MedRec -PPh -CLeAR Hospital -MedRec - 48-6 -PPh MedRec=Medication Reconciliation-Best Medication History PPh=Shared Care Polypharmacy-Most appropriate management-med review CLeAR=Call for Less Antipsychotics in Res care-Most appropriate mgt 48-6=Assess 6 areas within 48 hours, includes meds TiC=Transitions in Care, includes meds-Communication for planning PAD=Professional Academic Detailing in GP Offices-Med Knowledge
  3. 3. Med-Related InitiativesCommonalities • Purpose: Patients/Residents – Quality of life and safety, overall management, not just meds • Purpose: Medication Use – Appropriate, effective, reduce adverse drug events • Assessment, care planning, monitoring and review – Core functions across the initiatives
  4. 4. Medication-Related Initiatives • BCPSQC – Clinical Care Management • MedRec • 48-6 – CLeAR • MOH / BCMA Shared Care Committee • Polypharmacy in Elderly • Transitions in Care – Provincial Academic Detailing
  5. 5. Medication-Related Initiatives • Most are relatively new initiatives so need to bring together at initiative and local practice levels • Medication-related initiative workshop – Optimizing Medications: Time to bring the pieces together – January 16 & 17, 2014 in Vancouver – Announcement & registration coming later this month
  6. 6. Medication Reconciliation in Residential Care • Medication Reconciliation in long--term care is a formal process of: • At admission, obtaining a best possible medication history (BPMH), which is a complete and accurate list of each resident’s current and preadmission medications ---- including name, dosage, frequency and route. • Using the BPMH to create admission orders or comparing the list against the resident’s admission orders, identifying and bringing any discrepancies to the attention of the prescriber for resolution. • Any resulting changes in orders are documented and communicated to the relevant providers of care and resident or family member wherever possible.
  7. 7. Medication Reconciliation… • Is the foundation for: – more accurate medication review • Q6month reviews (physician, nursing, pharmacist) • Clinical review for appropriate prescribing – Polypharmacy in the Elderly algorithm – CLeAR • Is an important process to improve communication during re-admissions to residential care – Transfer to and from an acute care stay
  8. 8. Shared Care Polypharmacy • “Medication Review” is the basic technology • “De-prescribing” but can also be for prescribing, not only “indication” but decide in relation to other meds- ADEs • “Supported” decision-making – Algorithm – Targeted drug classes – Med review opportunities – Clinical information
  9. 9. Shared Care Polypharmacy • Phase 1-Prototyping 8 care facilities in BC • Phase 1A (2013/2014)- Expand care facilities • Phase 2 (2013/2015)- Acute Care/Transitions • Phase 3 (2014/2015)- Community
  10. 10. Shared Care Polypharmacy
  11. 11. RC Med Reviews Opportunities • Occasions for Full RC Medication Reviews – Scheduled Med Reviews – regular, but effective? – When first admitted – or during admissions process – Transitions – e.g. from Acute/ED, Special Care Unit – Review of Level of Intervention – or equivalent – Review of “standing orders” – e.g. Gravol 50mg • Occasions for Focused RC Medication Reviews – Episode of decline – symptom-directed, e.g. fall, delirium Addressing Polypharmacy in the Elderly 11 DRAFT 16/10/2013 – Request by staff – e.g. behaviour, med
  12. 12. Priority Drug List Drugs associated with: • Confusional States – antipsychotics, antidepressants, opioid analgesics, hypnotics • Adverse Drug Event-related Falls – antipsychotics, antidepressants (tricyclics), hypnotics, antihypertensives, hypoglycemics, anticonvulsants, antiparkinson meds, antihistamines • Significant Anticholinergic Effects – antidepressants (tricyclics), antihistamines, bladder meds • Bleeding – warfarin, antiplatelet meds • Indications Not Present (or no longer present) – statins, PPIs, analgesics, antihypertensives, antianginals, antipsychotics, antidepressants, osteoporosis meds Addressing Polypharmacy in the Elderly
  13. 13. Supports For Drug Review Decisions • Guide individualized consideration of patient-at-hand – Drug Advisory Sheets [drafts] PPIs STATINS ANTIPSYCHOTICS HYPNOTICS ANTIHYPERTENSIVES ANTIDEPRESSANTS BISPHOSPHONATES VITAMIN D & CALCIUM SUPPLEMENTS – Drug Brief: Calcium • Understanding of clinical condition – Condition Advisory Sheets STROKE PREVENTION IN THE ELDERLY (DRAFT) DEPRESSION IN THE ELDERLY (DRAFT) TREATING DIABETES IN THE FRAIL ELDERLY (FORTHCOMING) Materials are aligned with GPAC and OPUS materials – and will be reviewed by a Clinical Advisory Team Addressing Polypharmacy in the Elderly 13
  14. 14. 48-6 in Acute Care • Hospitalized seniors (aged 70 and older) • Integrated care initiative which addresses six care areas of functioning: medications, cognitive, mobility, bowel/bladder, nutrition, pain • Patient screening  Assessment  Individualized care plan, started within 48 hours if decision to admit  Discharge and/or transition plan
  15. 15. 48-6 in Acute Care • To reconcile all medications on admission and at discharge and to limit risk for medication reconciliation errors during transitions in care. • To complete an informed medication review to address potential medication adverse events. • To prevent adverse medication events in hospital. • To optimize the medications and simplify the regimens to make it easiest for the senior to adhere to their medication plan, making as few errors as possible.
  16. 16. Transitions in Care • Shared Care Committee-Physicians + Health Authority initiatives • Reduce re-admissions • Communication • Medications- 48-6, MedRec, Med Review • Involving Patients and Families- Patient Passport
  17. 17. PAD • • • • Provincial Academic Detailing Ministry of Health- Pharmaceutical Services In depth drug information in GP offices One drug class per period- Statins, Antibiotics, etc. • Interested in partnering for med-related initiatives
  18. 18. CLeAR • Main focus BPSD and antipsychotic medications but take a holistic view of the resident • Assessment, care plan with nonpharmacologic management approaches, monitoring and review   Algorithm • Inter-relates to other medication-related initiatives
  19. 19. Patient Community -PAD -PPh-2014/15 TiC Residential Care -MedRec -PPh -CLeAR Hospital -Med Rec - 48-6 -PPh MedRec=Medication Reconciliation-Best Medication History PPh=Shared Care Polypharmacy-Most appropriate management-med review CLeAR=Call for Less Antipsychotics in Res care-Most appropriate mgt 48-6=Assess 6 areas within 48 hours, includes meds TiC=Transitions in Care, includes meds-Communication for planning PAD=Professional Academic Detailing in GP Offices-Med Knowledge
  20. 20. Bringing Med-Related Initiatives Together-Care Scenario • Mrs. Brown is an 86 year old widowed woman, with a moderately severe Alzheimer disease, who has been recently admitted to your residential care facility from community. • Meds: Ramipril, Atorvastatin, Furosemide, Warfarin, Donepezil, Venlafaxine, Zopiclone, Thyroxine, Alendronate, Calcium, Vit D, Esomeprazole (Nexium) What med-related initiative is applied at admission and how? How else can meds be reviewed after an admission? How does this relate to care planning?
  21. 21. Care Scenario • A few months later, Mrs. Brown is not eating well and she appears to be more confused. She has a fall and she is sent to hospital. • What med-related initiatives would apply at her hospital admission and how would various approaches be integrated? • Mrs. Brown has a delirium and she is agitated so Risperidone is started. She settles in hospital and is discharged to facility. • What med-related initiatives apply at this transition stage and how will they be interrelated?
  22. 22. Care Scenario • The Risperidone was stopped after a few days in the care facility as it was thought that the agitation was in relation to a delirium. She returns to prior status. • A few months pass and Mrs. Brown is getting agitated with verbal aggressive behavior when getting care. • What would be the approach to care planning at this time, through integration of what med-related initiatives?
  23. 23. General Discussion How Can We Promote the Integration of the Various MedRelated Initiatives?
  24. 24. Polypharmacy Contact information • Website – www.bcma.org/polypharmacy-initiative • Contacts: Keith White, Physician Lead, Polypharmacy • E-mail: Shared_care@bcma.bc.ca

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