Transcript slides - swppa

An Innovative Approach to
Medication Management
Presenter: Mary Anne Foley, RN, MSN
Chief Operating Officer, Jewish Association on Aging
AgeWell Pittsburgh Collaboration
AgeWell Pittsburgh
• A coordinated effort of
– Jewish Community Center of Greater Pittsburgh
– Jewish Family & Children’s Service
– Jewish Association on Aging
• Provides a broad range of community-based services
to seniors living in the Pittsburgh community
• Helps older adults continue to live independently in their
own homes by identifying seniors at risk of losing
their independence and helping them connect to
services that will allow them to remain safely at home
HomeMeds℠ Program
“Any symptom in an elderly patient should be
considered a drug side effect until proved otherwise.”
(Gurwitz et al. 1995)
HomeMeds℠ Endorsement
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HomeMeds℠ is an approved Disease Prevention and Health Promotion
program
Included in the National Registry for Evidence-based Programs and Practices
(www.nrepp.samhsa.gov)
HomeMeds℠ is also included with a strong evidence rating on the US
Agency for Healthcare Research and Quality (AHRQ) Innovation Exchange
(http://www.innovations.ahrq.gov/content.aspx?id=2841)
The HomeMeds℠ system has been implemented in over 45 sites and 18
states
In the past four years, 11,000+ older adults have had their medications
screened for potential risks;
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40-50% of those screened had potential problems, the majority of which were resolved
through pharmacist collaboration with physicians, patients, families and care managers
Successfully implemented in area agencies on aging, senior centers, postacute care transitions programs, home-delivered meals programs, fall
prevention collaboratives, care management programs, housing and assisted
living
HomeMeds℠ Workflow
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Comprehensive in-home medication assessment
Electronic file created and data verified
Pharmacist notified of potential problem alert
Pharmacist sends med list & recommendation
to MD; intervention is documented
• Tracking of status and MD response
• Changes to meds & conditions are documented
and alerts are resolved
• Pharmacist advises patient and/or staff, if needed
HomeMeds℠ – Proven Solutions
Four important problem areas affecting seniors:
1. Unnecessary therapeutic duplication
2. Falls and confusion related to possible inappropriate psychoactive
medication use
3. Cardiovascular problems such as continued high/low blood
pressure or low pulse
4. Inappropriate use of non-steroidal anti-inflammatory drugs
(NSAIDs) in those with high risk of peptic ulcer/gastrointestinal
bleeding
Medications – From Help to Harm
The Problem
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Medication Errors are:
• Serious: 1.5 million Adverse Drug Events (ADE’s) annually;
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Over 700,000 people go to ED each year for ADE’s
7,000 deaths/year
Costly: Drug-related morbidity/mortality > $170 billion (ER,
hospital/readmissions, SNF use, etc.)
Common: Up to 48% of community-dwelling elders have
medication-related problems
Preventable: At least 25% of all harmful adverse drug
events are preventable
IOM , 2000. To Err is Human: Building a Safer Health System. Washington, D. C. National Academy Press.
IOM, 2007. Preventing Medication Errors. Washington, D.C. National Academy Press
Phase I
• HomeMeds was originally rolled out in Riverview
Towers, a more controlled environment with
specific safety controls built in:
– Case management resources were already available to all residents in
the building
– Riverview Towers is adjacent to the campus of one of the AgeWell
Pittsburgh Partners – Jewish Association on Aging (JAA)
– AgeWell Pittsburgh had an affiliate relationship with Riverview Towers
and was already providing some services in this building
– Many of the residents were already clients of AgeWell Pittsburgh
Phase II
• Phase II - Part I
• Assessments in additional facilities
– West Homestead HUD facility/Large percentage of Russian
speaking clients
– Beacon Place apartments/privately owned & managed
– JAA’s Adult Day Program
6-Month Pilot Data
HomeMeds Assessments Completed
Alerts Generated
Phase II
• Phase II - Part II
• Senior Center Pilot
– Targeting 200 older adults in senior center community
environments
• Bring medications/lists in to receive assessments
– Even though the program is called HomeMeds℠, it doesn’t
change the efficacy of it being an Evidence-Based Program
whether in the home or in a community-based setting
– Other cities across the country are currently using this
program in a community center model
HomeMeds℠ Pilot
Senior Center
• In 2015, AgeWell at the JCC received a grant from PA Dept. of Aging
to implement a pilot program in a Senior Center environment
• An MOU was established with Duquesne University’s Non-Profit
Pharmacy to serve as the Pharmaceutical partner
– Use of Pharm Interns, as well as Program personnel for screens
– Couple screens with education seminars, health fairs and “meet the pharmacist”
tables
• The Pilot consists of:
– An in-Center review of a comprehensive medication list with notes on how each
drug is to be taken, plus other indicators of adverse effects;
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vital signs, falls, symptoms, etc.
– Use of evidence-based protocols and processes to screen for risks and deploy
consultant pharmacist services appropriately
– Electronic medication risk assessment and alert process with report system
– Consultant pharmacist addresses problems with prescribers, seniors, families &
staff
How The Program Worked in a
Senior Center Environment
• Process
– Participants were recruited through our Senior Center programs,
word of mouth, flyers, and website information
– Time/date set to meet with pharmacy students or staff
– If signed up in person, the client will receive an informational
packet and an AgeWell brown bag
• The packet will include the appointment card with date, time;
informational consent form; business cards for the Duquesne
Pharmacy; and a reminder letter on what to bring to the appointment
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Meet to complete assessment at the senior center
Follow-up
Pharmacists/Pharmacy Students vs. staff
Register for other programs within the center
6-Month Pilot Data
HomeMeds Assessments Completed
Partnership Added Value Services
Experience an Assessment
HomeMeds℠ Assessment
HomeMeds℠ Assessment
HomeMeds℠ Assessment
HomeMeds℠ Assessment
HomeMeds℠ Assessment
HomeMeds℠ Assessment
HomeMeds℠ Assessment
Questions