Transcript VIHA Med Rec Home Care process

Home & Community Care
Medication Reconciliation
Coming Full Circle: AMI & Med Rec Across the Continuum
Western Node Collaborative
Medication Reconciliation
Process
• Medication Risk Assessment Tool (MedRAT)
identifies high risk clients requiring medication
reconciliation
• Best Possible Medication History (BPMH)
completed and sent to Physician for
reconciliation
• MedRAT and BPMH also sent to participating
Community Pharmacists for in-depth medication
review
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MEDICATION RISK ASSESSMENT TOOL
1.
IS THE CLIENTS MEDICATION REGIMEN
Simple
Complex (please see reverse for more information)
2.
IS THE CLIENT’S MEDICATION ADHERENCE BEST DESCRIBED AS:
Taking as prescribed
Chaotic (If chaotic, tick possible reasons below)
____ Impaired cognition
____ Impaired vision, hearing, swallowing
____ Lacks necessary support
____ Lower literacy or ESL issues
____ Side effects
____ Cost
____ Client’s beliefs/expectations
____ Lacks basic understanding of medications
____ Other (describe) _________________________________________
3.
IS THE CLIENT ON ANY HIGH-RISK MEDICATIONS?
( see reverse for more information)
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MEDICATION RISK ASSESSMENT TOOL
Examples of factors which increase complexity in a medication regimen:
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Greater than 5 medications (include prescription, OTCs, herbals, etc)
•
Greater than 3 times a day dosing frequency
•
More than 2 methods of medication administration – eg: oral, drops,
patches, nebulizers, etc
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More than 2 prescribers
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More than 2 pharmacies (include online pharmacy, if clients are using that)
•
Many OTC/herbal/alternative products
•
Multiple caregivers involved in medication administration (consider family,
neighbours, friends, Community Health Workers, etc)
•
Medications or doses changing frequently
Coming Full Circle: AMI & Med Rec Across the Continuum
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MEDICATION RISK ASSESSMENT TOOL
Examples of chaotic medication adherence:
(Occasional missed doses are considered “normal”)
•
No evidence of organized approach to medication administration
•
Blisterpacks that appear to be randomly punched out
•
Medications left out of containers and lying around the house
•
Client stating they’re not sure when they last took medications or that they
know they are forgetting some doses (more than occasionally), or that
they’re “mixed up” about their medications
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MEDICATION RISK ASSESSMENT TOOL
High-risk medications:
These medications are especially problematic for people in the over 65 years
of age group, but also carry some risk for those under 65:
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Narcotics
NSAIDs – eg: Advil, Ibuprofen
Anxiolytics – eg: Ativan, Buspirone
Antipsychotics
Digoxin
Anticoagulants – eg: Warfarin
Dilantin
Antihistamines
Tricyclic antidepressants – eg: Amitriptyline
Beta-blockers
Insulin
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Best Possible Medication History
Sources of Information
1.
2.
3.
4.
5.
6.
7.
8.
9.
Client Referral Form/Home Care Admission Orders
Client/Family/Caregiver
Acute Care Medication List/Profile
Discharge Orders/Prescriptions
RAI (Date RAI completed)____________
Provincial Drug Database
MAR
Medication Vials/Containers/Bubblepacks
Community Pharmacy
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Tools
• BPMH form
• Picture Tool
• Tips for Taking a Medication History
Coming Full Circle: AMI & Med Rec Across the Continuum
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Best Possible Medication History
Home & Community Care Medication Reconciliation
ALLERGIES:
PHYSICIAN INSTRUCTIONS
Please confirm the following medications currently being taken at home by ticking the appropriate boxes marked YES, NO or
CHANGE.
If any medications are to be discontinued or changed complete the physician orders attached, including reason for change and send
prescription to the Pharmacy.
Please Sign and Date at the bottom of the page where indicated
Home Medication Profile:
Continue at Home
PRESCRIPTION
Medications
Dose
Route
Frequency
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Discrepancies
Note Category
 Yes / No / Change (MRP)
YES
No
CHANGE
Order below
Western Node Collaborative
Best Possible Medication History
Categorization of Discrepancies:
0. No discrepancy
1. Med not currently prescribed
2. Different dose
3. Different frequency
4. Different route
5. Client no longer taking med
6. OTC – not taking as directed
7. Other
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Best Possible Medication History
Home & Community Care Medication Reconciliation
ALLERGIES:
The following is a list of all the non-prescribed medications this client is taking including the over the counters (OTC) and
Herbal medications
Please review as may have potential for interactions
Please Sign and Date at the bottom of the page where indicated
Home Medication Profile:
Select Over the Counter
Medications & Herbals
CLINICIAN
Name:_______________________
Date: _____________________
(print name)
Signature:___________________
Program:____________________
Phone:______________________
Fax: ______________________
Dose
Route
Frequency
DELEGATION OF TASK
Medications to be given by the
Community Health Worker
YES____ NO_____
** In order to be given by a
Community Home Support
Worker all oral medications must
be blister-packed.**
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Comments/Recommendations
PHARMACY
Pharmacy:________________
(print name)
Fax: ___________________
Phone: ___________________
Western Node Collaborative
Best Possible Medication History
Home & Community Care Medication Reconciliation
ALLERGIES:
PHYSICIAN ORDER for new or changed home medication (if CHANGE box ticked)
Date
Medication
Dose
Route
Frequency
Quantity
Repeats
Medication
Dose
Route
Frequency
Quantity
Repeats
Medication
Dose
Route
Frequency
Quantity
Repeats
Reason for change
Date
Reason for change
Date
Reason for change
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Picture Tool
Medications: More Than Just Pills!!!
Prescription Medicines
*These include anything you can only
obtain with a doctor’s order such as
heart pills, inhalers, sleeping pills.
AND
Over-The-Counter Medicines
*These include things that can be purchased at a
pharmacy without an order from the doctor such
as aspirin, Tylenol, laxatives, other bowel care products,
herbs like garlic and Echinacea or vitamins and
minerals like calcium, B12 or iron.
DON’T FORGET THESE TYPES OF MEDICATIONS
Eye Drops
Injections
Liquids
Patches
Nasal Sprays
Inhalers
Ointment/Creams
When talking with your doctor, nurse, or pharmacist always remember to include medicines you take every day,
but also include ones you only take sometimes such as for a cold, stomachache or headache.
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Tips for Taking a Med History
TIPS FOR TAKING A MEDICATION HISTORY
Question 1 relates to MedRAT Question 1 – simple vs complex medication regimen
1)
A complete medication profile – principle of “respectful sleuthing”
Names/phone no’s of all pharmacies used (check re use of online drug ordering).
Confirm client’s allergy list and describe any reactions to meds
Questions 2 and 3 relate to MedRAT Question 2 – adherence vs chaos
2)
Client’s perception of purpose of medications
Should know the basic names and purposes of each medication.
Client’s perception of effectiveness of medications
3)
Client’s ability to self-administer medications
Cognitive status – judgment, reasoning, understanding, diagnosis of dementia,
cognitive testing
Any physical/sensory/emotional barriers – fine motor control, vision, swallowing,
motivation
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Plan For Spread
• Integrate MedRAT into common practice for
Nurses and Case Managers
• Expand conditions for testing Med Rec process
- additional clinicians in Duncan
- SARIN Case Managers and HF Nurse
- another HU in South Island
• Hold the gains obtained and plan spread to
other Health Units
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Western Node Collaborative