Fraser Health's Approach to Polypharmacy

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Presented at the Optimizing Medications workshop by Gina Gaspard and Lori Blain

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Fraser Health's Approach to Polypharmacy

  1. 1. 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
  2. 2. Meet Mrs. Brown
  3. 3. 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?
  4. 4. Moving to residential care... • What medication-related initiatives apply upon transfer?
  5. 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 of care. •Residents receive quality medical care no matter their age, disease or socioeconomic status.
  6. 6. 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
  7. 7. Three Key Pieces Knowledge
  8. 8. Teamwork & System Resident & Family Patient Voices Network Nurse Practitioner Med Rec BPSD Guideline & Algorithm Palliative Approach Physicians Pharmacists Nurses CLeAR Communicare
  9. 9. What about knowledge gap?
  10. 10. 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.
  11. 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 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
  12. 12. What is Polypharmacy? More medications than clinically required or appropriate
  13. 13. Tables
  14. 14. 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
  15. 15. Decision – Making Tools 1. Surprise ? 2. Request for Information Form 3. Medication Indication Form 4. Nursing Assessment Guide
  16. 16. Transferred to Residential Care How does this impact Mrs. Brown?
  17. 17. Where we are now? • Draft Protocol with tools • Raising awareness through engaging stakeholders (formal & informal)
  18. 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 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.
  19. 19. 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
  20. 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. • • • • •
  21. 21. • • • • • Next steps Finish Protocol Process indicators Education plan Implementation plan Standardizing format for tools and uploading into system

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