Christine Gemeinhardt, Medical Coordinator
Edwin Lee, Pharmacist
Kelly Marshall, RN, Clinical Practice Leader
Cynthia Langenberg, Director of Health Services
And all other participating care staff
January 2013 – June 2013
Total # meds/99 residents
Total # meds/99 residents
Change in Meds Pilot Project
2.3 per resident
Time to backtrack……….
What made this project possible?
(Nursing homes are heterogeneous)
Tsawwassen, S Delta
Fraser Health Authority
99 residents - 13 Special Care Unit
KinVillage Polypharmacy Reduction Pilot Project
are at the end
of their life
quality of life,
not cure or
Earlier initiatives that made KV ripe for
a polypharmacy reduction project
2011 Hospital Transfer Reduction
2012 Education on the palliative
Use of FH Protocol for the
2012 KV Physician Agreement
Change in physician coverage
transfers from 10% to
meds & transfers
Number of different
MRPs from 23 to 14,
Number of residents
under Med Coordinator
too few residents
other areas of
Kin Village Physic ian Agreement
Dear Dr _______________________,
Your patient, _________________________________,
Complex Residentia l Care.
Eac h resident at Kin Village has a Ma in Responsible Physic ian (MRP).
fulfill the follow ing duties:
The MRP is asked to
Be ava ilable to rec onc ile the resident’s medi ations the day of admission
Visit the resident w ithin 2 w eeks of admission
Visit the resident routinely on a quarterly basis, review w ith nursing staff, and write
leg ible c hart notes
Provide timely onsite assessment and c are w hen the status of the resident c hanges
Provide timely onsite assessment prior to initiating transfer to hospital and c ommunic ate
w ith the Emergenc y Physic ian
Meet w ith the resident’s representative(s) in person to c omplete the MOST ( Fraser Health
Medic al Orders for Scope of Treatment) w ithin a w eek of admission.
Meet w ith the resident’s representative(s) during the end-of-life phase
Attend the resident during the end-of-life phase
Attend annual or biannual multidisc iplinary c are c onferenc es.
10. Provide a replac ement MRP w hen unavailable
In addition to the c are provided by the MRP, all Kin Village residents are review ed by the
Medic al Coord inator (MC). The MC is a physic ian w ho has particular interest and additiona l
training and experienc e in c omplex residential c are. The MC has been engaged by KinVillage
and the Fraser Health Authority. The MC prov ides oversight and makes recommendations for
resident medic al c are. This oversight c an be provided at the disc retion of the c are staff , Direc tor
of Hea lth Servic es, and MC at any time, not only during emergenc ies. The MC w ill strive to
c ommunic ate w ith the MRP w hen attending to a resident.
Please c hoose one of the follow ing:
I am able to fulfill the MRP duties and w ish to be MRP.
Dr _________________________ has c onsented to be MRP in my plac e.
I w ould like to be MRP but request that the MC assist w ith c are c onferenc es
medic ation reviews.
I w ould like to request that the MC assume MRP for my patient.
Also, I w ould like to acc ept orphaned residents.
as it relates to the resident
A highly individualized process
Other published guidelines
Kin Village Medication Review
Polypharmacy Reduction Initiative
Today we reviewed your res ident’s me dication profile us ing curre nt polypharmacy
reduction strategies and c linica l assessment. We recommend disc ontinuing medications
that are deemed harmful, unnecessary, or of dubious benefit in the frail, e lderly
residentia l population. We recommend reviewing dosages of medications and poss ibly
decreasing them. We recommend re moving unused prn medications from the medication
list. We are also attempting to simplify the reside nt’s drug regimen.
Re comme ndations
It is a pleasure working with you in caring for this resident. We welcome your comments
Christine Geme inhardt, Medica l Coordinator, 604-317-8721
Edwin Lee, Pharmac ist, 604-943-9341
Nadine Brown, RN, Clinical Practice Leader, 604-943-0155
Med Review Team to nursing staff
Nursing to family
Med Coordinator to family
Med Coordinator to community GP
Nurse to community GP
Community GP to pharmacist
Nurse to pharmacist
Nursing routine disrupted
Nursing staff buy-in
Community physician buy-in
Sustainability - results
Long Term Sustainability
review 1 week