The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Re-establishing autonomy in elderly frail patients, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Design of Accountable Care OrganizationsCJ Fulton
Pillars for Accountable Care
PCMH versus ACOs
Core competencies
Six core structural components of successful ACO deployment
Pioneer ACO burn and learn lessons
Barriers & root cause analysis
Patient attribution
Five modes of Accountable Care
Early value-based adopters
Value discovery assessment
Modified Triple Aim
GPRO
Breakdown by 33 Measures
The AHSN Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing Problematic Polypharmacy in Haringey Care Homes, can be viewed here.
For more information about the polypharmacy programme, please visit https://www.ahsnnetwork.com/programmes/medicines/polypharmacy/
Description This is a continuation of the health promotion pro.docxmecklenburgstrelitzh
Description
This is a continuation of the health promotion program proposal, part one, which you submitted previously. Please approach this assignment as an opportunity to integrate instructor feedback from part I and expand on ideas adhering to the components of the MAP-IT strategy. Include necessary levels of detail you feel appropriate to assure stakeholder buy-in.
Directions
For this assignment add criteria 5-8 as detailed below:
5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which include resources necessary, those involved, and feasibility for a nurse in an advanced role. Be certain to include a timeline. ( 3 paragraph. You may use bullets if appropriate).
6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach. (1 paragraph).
7. Provide a detailed plan for evaluation for each outcome. (1 paragraph).
8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (1 paragraph).
9. Conclude the paper with a Conclusion paragraph. Don’t type the word “Conclusion”. Here you will share your insights about this strategy and your expectations regarding achieving your goals. (1 paragraph).
Paper Requirements
Your assignment should be 3 pages (excluding title page, references, and appendices), following APA standards.
Remember, your Proposal must be a scholarly paper demonstrating graduate school level writing and critical analysis of existing nursing knowledge about health promotion.
Please add this section to the PART 1 ATTACHED , must be one document for the entire work, AGAIN this 4 pages you will do now, please add it to the PART 1 ATTACHED, add references for this section and put them properly in APA style with the previously in the PART 1.
[removed]
Running head: CONGESTIVE HEART FAILURE Page 2
Patients with Congestive Heart failure and Increased Readmission Rates
Florida National University
NGR 6638
Professor Alexander Garcia Salas DNP, MSN, ARNP, FNP-C
Congestive heart failure (CHF), which affects millions of people, especially the elderly, is a significant and expanding public health concern. According to research, CHF accounts for between 12 and 15 million office visits and 6.5 million inpatient days annually (Hollier, 2021). Unfortunately, this approach leads to disease progression and rehospitalizations for many CHF patients because of insufficient care, unclear discharge instructions, and a lack of follow-up visits. These higher rehospitalization rates are driving up expenses and indicating that existing care strategies for CHF are not the most effective. Therefore, evidence-based t.
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
The Design of Accountable Care OrganizationsCJ Fulton
Pillars for Accountable Care
PCMH versus ACOs
Core competencies
Six core structural components of successful ACO deployment
Pioneer ACO burn and learn lessons
Barriers & root cause analysis
Patient attribution
Five modes of Accountable Care
Early value-based adopters
Value discovery assessment
Modified Triple Aim
GPRO
Breakdown by 33 Measures
The AHSN Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing Problematic Polypharmacy in Haringey Care Homes, can be viewed here.
For more information about the polypharmacy programme, please visit https://www.ahsnnetwork.com/programmes/medicines/polypharmacy/
Description This is a continuation of the health promotion pro.docxmecklenburgstrelitzh
Description
This is a continuation of the health promotion program proposal, part one, which you submitted previously. Please approach this assignment as an opportunity to integrate instructor feedback from part I and expand on ideas adhering to the components of the MAP-IT strategy. Include necessary levels of detail you feel appropriate to assure stakeholder buy-in.
Directions
For this assignment add criteria 5-8 as detailed below:
5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which include resources necessary, those involved, and feasibility for a nurse in an advanced role. Be certain to include a timeline. ( 3 paragraph. You may use bullets if appropriate).
6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach. (1 paragraph).
7. Provide a detailed plan for evaluation for each outcome. (1 paragraph).
8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (1 paragraph).
9. Conclude the paper with a Conclusion paragraph. Don’t type the word “Conclusion”. Here you will share your insights about this strategy and your expectations regarding achieving your goals. (1 paragraph).
Paper Requirements
Your assignment should be 3 pages (excluding title page, references, and appendices), following APA standards.
Remember, your Proposal must be a scholarly paper demonstrating graduate school level writing and critical analysis of existing nursing knowledge about health promotion.
Please add this section to the PART 1 ATTACHED , must be one document for the entire work, AGAIN this 4 pages you will do now, please add it to the PART 1 ATTACHED, add references for this section and put them properly in APA style with the previously in the PART 1.
[removed]
Running head: CONGESTIVE HEART FAILURE Page 2
Patients with Congestive Heart failure and Increased Readmission Rates
Florida National University
NGR 6638
Professor Alexander Garcia Salas DNP, MSN, ARNP, FNP-C
Congestive heart failure (CHF), which affects millions of people, especially the elderly, is a significant and expanding public health concern. According to research, CHF accounts for between 12 and 15 million office visits and 6.5 million inpatient days annually (Hollier, 2021). Unfortunately, this approach leads to disease progression and rehospitalizations for many CHF patients because of insufficient care, unclear discharge instructions, and a lack of follow-up visits. These higher rehospitalization rates are driving up expenses and indicating that existing care strategies for CHF are not the most effective. Therefore, evidence-based t.
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
SVMPharma Real World Evidence - Randomised controlled trials were never desig...SVMPharma Limited
SVMPharma Real World Evidence - Conventional RCTs are necessary for determining efficacy and safety, but real-world clinical practice can be very different. RWE complements RCT data and offers the opportunity to bridge the data gaps.
Have you identified your data gaps? For more information and resources visit us at www.svmpharma.com
Deprescribing of Benzodiazepines in the Elderly Using A 3Es Model: A Patient ...pateldrona
Benzodiazepines use in the elderly are associated with morbidity including increased falls, fractures, and mortality. The common reason for re-prescribing benzodiazepine by physicians is dependency. Our project proposal aims to enhance medication safety in the elderly. It requires a multidisciplinary approach and patient-centred care focusing on benzodiazepine deprescribing using the 3Es model of Educating, Empowering, and Engaging. The education starts with patients, providers, and the community about benzodiazepine adverse effects on the elderly and provides alternative approaches for symptoms management.
Deprescribing of Benzodiazepines in the Elderly Using a 3Es Model: A Patient ...komalicarol
Benzodiazepines use in the elderly are associated with morbidity including increased falls, fractures, and mortality. The common reason for re-prescribing benzodiazepine by physicians is
dependency. Our project proposal aims to enhance medication
safety in the elderly. It requires a multidisciplinary approach and
patient-centred care focusing on benzodiazepine deprescribing
using the 3Es model of Educating, Empowering, and Engaging.
CBME (Competency Based Medical Education) curriculum is available for medical students
who were drowning in the sea of old information. Now the students will be able to inculcate
new competencies which include different skills, knowledge and attitude which a student
should possess while dealing with the patients keeping their behaviour within ethical
boundaries. The topics explained in the manual are given with relevant examples along with
the case scenarios wherever it is required for better grasping of the topic by the students.
The main aim of writing this book is to create awareness among the medical students about
the importance and requirement of ethical principles and moral conduct of a qualified
professional doctor while approaching the patient and also educate them about various aspects
of drug use, hands on training for administration of drugs, writing a rational prescription,
identifying & reporting adverse drug reactions also to motivate chronically ill patients to
adhere to the prescribed treatment. Sincere effort has been made to provide the relevant
content based on new competencies for the better and easy understanding of the medical
students.
New relevant competencies have been added to the second edition of the book. Colored graphs
to demonstrate the effects of drugs on BP have also been included. Students of MBBS
(Medicinae Baccalaureus Baccalaureus Chirurgiae) and other courses related to healthcare will
be benefitted through this book.
Pharmacoeconomic Evaluation of an Antibiotic Streamlining ServiceMarielleFares1
This presentation describes a pharmacist-led antibiotic streamlining service initiative in hospitals in Beirut, and impact on drug costs, length of stay, and rate of hospital admissions
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing opioid prescribing, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
Pharmacist Interventions and Medication Reviews at Care Homes - Improving Med...Health Innovation Wessex
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Pharmacist Interventions and Medication Reviews at Care Homes - Improving Medication Safety and Patient Outcomes, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
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SVMPharma Real World Evidence - Conventional RCTs are necessary for determining efficacy and safety, but real-world clinical practice can be very different. RWE complements RCT data and offers the opportunity to bridge the data gaps.
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Benzodiazepines use in the elderly are associated with morbidity including increased falls, fractures, and mortality. The common reason for re-prescribing benzodiazepine by physicians is dependency. Our project proposal aims to enhance medication safety in the elderly. It requires a multidisciplinary approach and patient-centred care focusing on benzodiazepine deprescribing using the 3Es model of Educating, Empowering, and Engaging. The education starts with patients, providers, and the community about benzodiazepine adverse effects on the elderly and provides alternative approaches for symptoms management.
Deprescribing of Benzodiazepines in the Elderly Using a 3Es Model: A Patient ...komalicarol
Benzodiazepines use in the elderly are associated with morbidity including increased falls, fractures, and mortality. The common reason for re-prescribing benzodiazepine by physicians is
dependency. Our project proposal aims to enhance medication
safety in the elderly. It requires a multidisciplinary approach and
patient-centred care focusing on benzodiazepine deprescribing
using the 3Es model of Educating, Empowering, and Engaging.
CBME (Competency Based Medical Education) curriculum is available for medical students
who were drowning in the sea of old information. Now the students will be able to inculcate
new competencies which include different skills, knowledge and attitude which a student
should possess while dealing with the patients keeping their behaviour within ethical
boundaries. The topics explained in the manual are given with relevant examples along with
the case scenarios wherever it is required for better grasping of the topic by the students.
The main aim of writing this book is to create awareness among the medical students about
the importance and requirement of ethical principles and moral conduct of a qualified
professional doctor while approaching the patient and also educate them about various aspects
of drug use, hands on training for administration of drugs, writing a rational prescription,
identifying & reporting adverse drug reactions also to motivate chronically ill patients to
adhere to the prescribed treatment. Sincere effort has been made to provide the relevant
content based on new competencies for the better and easy understanding of the medical
students.
New relevant competencies have been added to the second edition of the book. Colored graphs
to demonstrate the effects of drugs on BP have also been included. Students of MBBS
(Medicinae Baccalaureus Baccalaureus Chirurgiae) and other courses related to healthcare will
be benefitted through this book.
Pharmacoeconomic Evaluation of an Antibiotic Streamlining ServiceMarielleFares1
This presentation describes a pharmacist-led antibiotic streamlining service initiative in hospitals in Beirut, and impact on drug costs, length of stay, and rate of hospital admissions
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing opioid prescribing, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
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The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Pharmacist Interventions and Medication Reviews at Care Homes - Improving Medication Safety and Patient Outcomes, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, SBAR Patient Engagement Tool, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing medication related falls risk in patients with severe frailty, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Assessing the outcomes of structured medication reviews, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Polypharmacy SMR reviews in outpatient bone health clinics, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
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To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Polypharmacy reviews of asthma and COPD patients over 65 and 10 or more medicines, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
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Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Evaluating the impact of a specialist frailty multidisciplinary team pathway with clinical pharmacist involvement, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
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Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, To evaluate the benefits of Structured Medication Reviews in elderly Chinese patients, can be viewed here.
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Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
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For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
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The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Improving care in County Durham under the STOMP agenda - A 5 year review, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
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The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
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To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Impact of an EMIS search to prioritise care home residents for a pharmacist led medication review, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
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Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Identifying Orthostatic Hypotension caused by Medication, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/
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Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, How do you best get that message across, can be viewed here.
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This includes tasks like:
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Administering medications and treatments.
Performing procedures as directed by doctors.
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Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
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Counseling families on safety and injury prevention.
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The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...
Re-establishing autonomy in elderly frail patients.pdf
1. Re-establishing Autonomy in Elderly Frail Patients
Dr Rute Rosa-Marsh (PharmD)
Dr Rute Rosa-Marsh, PharmD ruterosa.marsh@dorsetgp.nhs.uk
PDSA PLAN DO STUDY ACT
#1 Elderly frail patients’
selection
Select patients taking ≥1 drugs with ACB=3:
Run a S1 report to populate >60yo patients
taking any Ach drug with ACB=3 using the
following ACB scale. 6 All eligible patients or
respective carers to be contacted asking
permission to participate in the study.
Assess, classify and record individual
patient frailty level using Rockwood Frailty
Scale Questionnaire and Classification
Tree. 7,8,9 Performed by the Frailty Clinical
Pharmacist.
Reduce the cohort population by
selecting those with Clinical Frailty Score
(CFS) ≥ 4 ≤7. Reassess as per PDSA #4 to
assess progress.
#2
Determine cognitive
decline baseline
Ask each eligible patient carer or family
member to answer the Informant
Questionnaire on Cognitive Decline in the
Elderly (IQCODE)9: The same carer/family
member must be used all time this
questionnaire is answered to keep
consistency.
Establish each patient cognitive decline
baseline score: Collect and record each
patient IQCODE score and alert patient
carer/family member to pay attention and
record any changes in each of the
questionnaire elements along the study, in
order to keep accurate measurements of
changes along the study.
Reassess as per PDSA #4 to assess
progress.
#3 Reduce total AEC
score to ≤2
Using PDSA#1 final cohort, invite patients
(and/or carers) for a SMR. Obtain consent
and discuss: patient concerns about their
current medication; if they are coping with
current regime; what are the patient
preferences, and if there are any drugs they
feel that are no longer needed and why.
Investigate if patient takes all currently
prescribed medication as indicated and if
any medication is not taken, why is that so.
Discuss the meaning of AEC and its effect in
the individual quality of life, explaining the
importance of reducing the AEC score and
its relation to quality of life and
independence improvement.
Quantify each patient current total AEC:
All eligible patients are to have each of
their taken medications scored for AEC
and total AEC score calculated using the
following classification tool. 10
Switch current Ach drugs to another
appropriate drug with the lowest AEC
score possible. Always follow local
formulary indications as much as
possible, and respect NICE guidelines
regarding initiation and monitoring all
times. Aim to achieve a total AEC of 2 or
less when possible. When planning
multiple Ach drugs switches, switch one
at each step of the process: start by
switching the drug with the highest AEC
first, when possible, safe and appropriate.
Repeat this PDSA in conjunction with
PDSA #4 according to results.
#4 Determine
outcomes
Using PDSA #1 and PDSA #2 assessment
tools, reassess patients CFS and IQCODE at
weeks 4, 12, 24 post each PDSA #3
medication optimisation cycle.
Collect CFS, IQCODE scores and AEC
changes and analyse patients progress and
correlation of CFS/IQCODE and AEC
reductions.
Run a patient satisfaction survey, and
possibly publish the QI study outcomes.
Develop a policy in anticholinergic de-
prescribing for our PCN.
BACKGROUND
It has been established that a high ACB/AEC scores are intimately related to frailty and cognitive decline levels, and that drugs
with a high AEC score are those with the highest impact. This issue is most found in polypharmacy patients and has a worse
outcome in frail elderly patients due their complex clinical nature. Tackling polypharmacy demands a careful and thorough
clinical judgement and a well-planned strategy to implement the necessary changes to avoid or slow down frailty and cognitive
decline levels and re-establish patient independence where possible. This type of process is quite time consuming but still less
expensive on a long run when compared with the daily cost of risks related hospital admissions and care plans. 1–6
AIMS
To demonstrate that focused and comprehensively planned SMR’s in complex multimorbidity elderly patients can contribute to
reducing frailty and cognitive impairment levels by tackling polypharmacy related risks using relevant available tools. Achieve an
AEC of ≤2 in the subject population of our GP practice to improve patient care quality, patient QoL and reduce polypharmacy
related hospitalisations and NHS costs overall. To show that investing time in quality SMR’s has lower economical burden to NHS
when compared to related hospitalisations and care plans.
People
Communication
Process
Equipment
Culture
Environment
No ACB/AEC check: Hospital
Discharge/Consultant Letters
Patient is seen by
several medical
professionals due to
multimorbidity
Clinical Professionals workload:
Lack of time, funding, support,
trained staff/experts
Lack of awareness and knowledge
about ACB/AEC polypharmacy
consequences
Communication challenges: Inter-
professionals;
Clinician-patient
S1/EMIS/Ardens no automatic
alert for ACB/AEC score ≥2
Local/National
formularies/Guidelines
Cognitive Impairment development
Increased Frailty and Cognitive
Impairment Levels
REFLEXIONS AND SUGGESTIONS
Always make my SMR’s patient wellbeing focused and not
strictly budget focused;
Improve self-confidence of sharing my knowledge with more
senior clinicians than me and challenge their clinical
therapeutical choices appropriately.
Contact The Phoenix Partnership (TTP) and Ardens to suggest
total ACB/AEC alert algorithm;
Use Clinical Meetings to spread awareness of ACB/AEC
consequences importance;
Propose local CCG to fund a campaign to train other clinical
professionals and increase awareness regarding ACB/AEC.
RESULTS
RESULTS INTERPRETATION/CONCLUSION
A reduction of AEC score can contribute to a decrease in
Rockwood Frailty Scale and IQCODE scores. This revealed some
autonomy re-establishment in the 2 patients of this study so
far. It also contributes to increase patient safety by reducing
polypharmacy related risks such as dizziness and drowsiness,
which are frequently associated with fractures in elderly frail
patients. Therefore, increased patient care quality, patient
QoL, NHS costs savings overall, patient satisfaction and
possibly lifespan extension.
Investing time in carefully planned SMR’s can lead to higher
quality care and lower burden to the NHS in general.
GP
Nurse
Rheumo
Memory Clinic
Urologist
Pain Clinic
Polypharmacy Champion
ACB
LEARNINGS AND CHANGES
• ePACT2: Polypharmacy prescribing comparators. ACB score is incorporated into
indicators available through ePACT2, which identifies numbers of patients with
ACB scores ≥6, ≥9 or ≥ 12 in a month.
• Performing AEC/ACB score screens at any Ad-Hoc opportunity: discharges,
letters, SMR’s, repeat prescriptions authorisations.
• Influencing colleagues about ACB/AEC importance.
• Importance of always putting patient health best interest first, regardless time
constraints.
6
2
Patient X AEC reduction AEC 6 AEC 2
Time (wks) FCS IQCODE
0 6 3.38
4 6 3.12
8 6 3.01
12 5 2.89
Figure 2. Rockwood Frailty Scale 10
REFERENCES
1. Bell B, Avery A, Bishara D, Coupland C, Ashcroft D, Orrell M. Anticholinergic drugs and risk of dementia: Time for action? Pharmacol Res Perspect. 2021;9(3). doi:10.1002/PRP2.793
2. Scottish Government Polypharmacy Model of Care Group. Polypharmacy Guidance, Realistic Prescribing 3 rd Edition, 2018. Scottish Government. Published 2018. Accessed September 19, 2022. https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf
3. Gorup E, Rifel J, Petek Šter M. Anticholinergic Burden and Most Common Anticholinergic-acting Medicines in Older General Practice Patients. Slovenian Journal of Public Health. 2018;57(3):140. doi:10.2478/SJPH-2018-0018
4. Cardwell K, Hughes CM, Ryan C. The Association Between Anticholinergic Medication Burden and Health Related Outcomes in the ‘Oldest Old’: A Systematic Review of the Literature. Drugs Aging. 2015;32(10):835-848. doi:10.1007/S40266-015-0310-9
5. Bulletin 253: Anticholinergic burden | PrescQIPP C.I.C. Accessed September 19, 2022. https://prescqipp.info/our-resources/bulletins/bulletin-253-anticholinergic-burden/
6. PrescQIPP. B140. Anticholinergic drugs 2.1. Accessed September 19, 2022. www.prescqipp.info
7. Aging Brain Program of the Indiana University Center for Aging Research. ANTICHOLINERGIC COGNITIVE BURDEN SCALE. Published 2012. Accessed September 19, 2022. https://gwep.med.ucla.edu/files/view/docs/initiative2/conferences/Anticholinergic-Burden-Scale.pdf
8. Clinical Frailty Scale Health Questionnaire. Accessed September 19, 2022. https://cdn.dal.ca/content/dam/dalhousie/pdf/sites/gmr/2021-08-03_CFS%20Questionnaire%20Online%20Version.pdf
9. CFS Classification Tree - Geriatric Medicine Research - Dalhousie University. Accessed September 19, 2022. https://www.dal.ca/sites/gmr/our-tools/clinical-frailty-scale/cfs-classification-tree.html
10. Clinical Frailty Scale (Rockwood) : Frailty Toolkit. Accessed September 19, 2022. https://www.frailtytoolkit.org/rockwood/
11. Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) | Doctor | Patient. Accessed September 19, 2022. https://patient.info/doctor/informant-questionnaire-on-cognitive-decline-in-the-elderly-iqcode
12. Medichec. Accessed September 19, 2022. https://medichec.com/
Table 1. Patient X IQCODE results along time 11
Figure 1. Patient X MEDICHEC AEC score comparison 1
Oxybutynin
Solifenacin
Promethazine
Hydroxyzine
3
3
1
1