medication management support services mmss aging at home
play

Medication Management Support Services (MMSS) Aging at Home Mary - PowerPoint PPT Presentation

Medication Management Support Services (MMSS) Aging at Home Mary Burello-Cordovado Senior Manager, Client Services, Special Projects March 3, 2010 Objectives Update on Medication Management Support Services (MMSS) as an Aging at Home


  1. Medication Management Support Services (MMSS) Aging at Home Mary Burello-Cordovado Senior Manager, Client Services, Special Projects March 3, 2010

  2. Objectives • Update on Medication Management Support Services (MMSS) as an Aging at Home Strategy • Provide an overview of the project and case examples of success • How does MMSS keeps older adults healthy at home? • Review outcomes and demonstrate quality measures to date • Demonstrate how MMSS can reduce potential ED visits 2

  3. Background • In June 2008, the Central LHIN approved the Medication Management Support Services (MMSS) project. • The organizations involved: • Central CCAC – Project Lead • SRT Med Staff • COTA Health now VHA Rehab Services • York Central Hospital • Southlake Regional Health Centre • New members: • St. Elizabeth Health Care • Acute care hospitals in Central LHIN 3

  4. Central York CCAC SRT Med Central Sta f f Inc. hospital St. Physicians Elizabeth Client/ Health Caregiver Care Hospitals VHA Rehab Community Pharmacist 4

  5. Seniors + Medications = ER visits? Seniors + Medications = ER visits? ADEs account for an estimated 10-17% of admissions to hospital involving elderly patients (Hayes et al, 2007), and it has been suggested that as many as 75% of these admissions could have been prevented if medications had been used appropriately (reviewed in Gallagher et al, 2007) 5 Adapted from Polypharmacy in the Frail Elderly (GiiC)

  6. High Risk Issues • Canadian Study (CMAJ June 3, 2008 – ZED PJ et al) • 122 patients had medication-related admissions • 83 of these were deemed preventable* Most Com m on Medication Problem Adverse Drug Reaction 39.3% Non-adherence 27.9% * Improper Dose 12.3% Improper Drug Selection 11.4% Untreated Indication 9.0% 6

  7. Value Stream Analysis: August 2008 • 3-day event with: • Project Partners • ISMP was in attendance as well as a representative from the Pharmacy Association • Staff from prior Scarborough CCAC project • Identified that existing processes show duplication of effort • Too many lists completed and not shared • Meds Check not well-known • Central CCAC clients would benefit from medication reconciliation 7

  8. What is the Eligibility Criteria? • Mandatory Criteria • 65 years or older • Taking three (3) or more medications • Has one (1) or more chronic diseases • Valid OHIP; eligible for CCAC services • Resident of Central CCAC • One or more risks as identified in eligibility criteria (falls, frequent visits to ER/ hospitalizations, uncontrolled pain) 8

  9. Medication Management Support Services • Phase 1: MMSS1 – Nursing • 2 visits in 30 day period • Phase 2: MMSS2 – Pharmacy • 2 visits in 30 day period • CCAC Case Manager/ Service Provider can recommend Phase 1 or Phase 2 of MMSS depending on complexity of client • Clients in Phase 1 can be referred to Phase 2 by the nurse provider or CCAC 9

  10. How have the clients benefited? • Enables nurse and pharmacist to: • Create a complete and accurate inventory of all medications • Prescribed/ over-the-counter/ herbal • Review storage and organization of medications • Assess the appropriateness of medications • Assess client/ caregiver self-administration/ caregiver skill and methods 10

  11. How have the clients benefited? • Determine any cognitive deficits which would prevent the client/ caregiver from safely administering medication • Determine any physical deficits which impede client/ caregiver ability to administer the prescribed medication • Reduced vision, decrease in manual dexterity • Compare the current medications with medications prescribed • Identify any discrepancies/ medication related problems • Bring it to the attention of the prescribing physician 11

  12. What can the client expect? • The nurse or pharmacist completes and provides a medication schedule • After confirmation and discrepancies are resolved with the prescribing physician • Makes recommendations • The need for aides or cues • Blister pack/ Compliance packaging or dosette system, visual reminders • Make recommendations • Additional or increased services • Increased PSW hours for reminders, OT assessment, referral to a community support agency, nursing visits • Educate the client/ caregiver regarding medications, side-effects, dose, administration times, and procurement of medications • Storage • Copy of the schedule is then sent to the family physician 12

  13. Medication Management Support Services “ W here Principles of Pharm acy Practice Converge” Albert Chaiet, R.Ph., B.Sc.Phm., M.Sc.Phm., M.B.A. Director, Pharmacy Services, York Central Hospital 13

  14. Convergence • Standards of Practice • Pharmaceutical Care • Medication Reconciliation • CSHP 2015 14

  15. Standards of Practice • Ontario College of Pharmacists • Canadian Society of Hospital Pharmacists 15

  16. Pharmaceutical Care • Identifying and resolving potential or actual drug related problems • Care planning • Ethics of care • Duty of care 16

  17. Medication Reconciliation • Accreditation Canada R.O.P.s • BPMH on admission • Reconciliation at transfer points including discharge 17

  18. 18

  19. C.S.H.P. 2015: Goal 2 • “Increase the extent to which pharmacists help individual non-hospitalized patients achieve the best use of medications” • Objective 2.3: In 85% of home care services, pharmacists will manage medication therapy for patients with complex and high-risk medication regimens, in collaboration with other members of the healthcare team” 19

  20. A Pharmacist Home Visit … … … A Pharmacist Home Visit … • Can unlock the door to the problem • We can see exactly what the patient has at home (contrary to a list!) • Patient is comfortable in their surroundings • Minimal distractions • Environment scan to see how managing the medications • Pharmacists are very skilled at dealing with medication issues 20

  21. Identifying limitations Identifying limitations • Physical • Cognitive • Accessibility • Adherence • Safety • Knowledge • Storage and Organization 21

  22. Interventions for Disease Prevention or Interventions for Disease Prevention or Management Management • Indications are appropriately treated • Preventative medicine is used and Rx’d appropriately (e.g. Vitamin D, EC ASA) • Administration techniques appropriate • Disease exacerbation – knows the plan • When to use Nitroglycerin Spray • SOB – what puffer to have handy • Uncontrolled B.S. when sick 22

  23. Medication Management Visit Means: Medication Management Visit Means: • Asking the patient for their desired goals from their medication • Educating • Acting as an advocate for the patient • Recommending professional services to benefit the patient Assess all com ponents of their m edications for: Safety, Simplicity and Correctness 23

  24. Case Case Discharge from Hospital Discharge from Hospital • Direct referral to pharmacy • Direct referral to pharmacy • Client on blister pack system • Client on blister pack system • Blister pack filled according to D/ C rx rx • Blister pack filled according to D/ C • Community phm phm contacted hospital MD regarding contacted hospital MD regarding • Community insulin – – not on Rx not on Rx insulin • • Instructed to tell client to Instructed to tell client to f/ u f/ u with family MD with family MD • Client to see family MD in 5 days • Client to see family MD in 5 days 24

  25. Pharmacist Home Visit Pharmacist Home Visit • • Had medication reconciliation form, labs and copy of D/ C rx Had medication reconciliation form, labs and copy of D/ C rx from hospital records from hospital records • First question they asked – – “ “ What about her insulin? What about her insulin?” ” • First question they asked • Hospital increased oral BS meds to control DM – – not not • Hospital increased oral BS meds to control DM knowing she used insulin at home knowing she used insulin at home • Family MD appt in 5 days. Been on oral regimen for last 3 • Family MD appt in 5 days. Been on oral regimen for last 3 weeks in hospital B.S. not too bad (assess urgency) weeks in hospital B.S. not too bad (assess urgency) 25

  26. Pharmacist Home Visit Pharmacist Home Visit • Reviewed blister pack – – rx rx’ ’s s all correct from all correct from • Reviewed blister pack discharge Rx discharge Rx • Iron being given at breakfast (interacts with her • Iron being given at breakfast (interacts with her levothyroxine) and bedtime ) and bedtime levothyroxine • + + heartburn and upset stomach – – PPI switched PPI switched • + + heartburn and upset stomach at time of discharge, Metformin Metformin or Ferrous or Ferrous at time of discharge, gluconate could be contributing gluconate could be contributing • c/ o tingling in fingers • c/ o tingling in fingers • • Community phm Community phm helped chg helped chg Pariet Pariet to her normal to her normal PPI of Prevacid Prevacid and and chg chg’ ’d d timing of iron timing of iron PPI of 26

Recommend


More recommend