| Medication management may be one of the greatest | | | | something special," she says. |
| clinical challenges in senior living, where the average | | | | Systemic Strategies |
| resident may take four to six medications a day, or | | | | Underlying all these basic strategies, successful |
| more. Yet the assisted living business has earned a | | | | administrators demonstrate a commitment to a |
| reputation for consistent positive performance in this | | | | systematic approach to medication management. To |
| arena. | | | | get the right drugs and dosages into the right hands |
| "A major reason people move into assisted living is | | | | at the right time, appropriate systems must be in |
| that they need help with medications, so it is a | | | | place and safety protocols must always be |
| service we take very seriously," says Maribeth | | | | consistent and repeatable. |
| Bersani, ALFA's senior vice president for public policy. | | | | Best systemic practices in medication management |
| "We are training people, we are monitoring them, we | | | | cover a lot of ground. Strategies can be incredibly |
| are doing it safely and doing it well." | | | | detailed. A few that are absolutely worth |
| The numbers bear it out. Looking at all medication | | | | implementing include the following: |
| mistakes with the exception of time errors, assisted | | | | Get stakeholders involved. Staff, physicians, and |
| living shows an error rate of 8.2 percent versus 10 | | | | pharmacists all should have a chance to offer input |
| percent in hospitals, according to Heather M. Young, | | | | into the plan, since they will be the ones to put it in |
| Ph.D. and GNP, et al. in their paper, Types, | | | | practice. Transfers are crucial. Check the labels of |
| Prevalence, and Potential Clinical Significance of | | | | everything coming from home or from the hospital. |
| Medication Administration Errors in Assisted Living. | | | | Read back phone orders and don't hang up without |
| It takes a range of best practices for assisted living | | | | verbal verification. If a resident is self-administering, |
| providers to score consistently high in the realm of | | | | confirm every quarter that the resident is still capable |
| medication management. | | | | of the task. "Success comes from having the right |
| Internal Vigilance | | | | systems and protocols in place," Kaes says. "By |
| Some 1.5 million people receive the wrong medication | | | | constantly reviewing and observing those who |
| or the incorrect dose each year, according to the | | | | dispense medications, it allows us to ensure that |
| Institute of Medicine, part of the National Academies | | | | people are getting the right medications in the right |
| of Science. Yet assisted living has a history of | | | | manner." |
| positive procedures that help ensure accurate dosing, | | | | The biggest and broadest effort has to do with |
| of-ten in response to systemic causes that originate | | | | handling procedures among the staff: where and how |
| outside assisted living. | | | | medicine is received, stored, and dispensed. Every |
| Sandi Flores, RN points to poly-pharmacy as one | | | | residence will do this differently. So long as the |
| example. "One of the major factors is the sheer | | | | procedure is easy to understand and simple to |
| number of meds our residents are taking," says | | | | implement, the "how" will matter less than the |
| Flores, director of clinical services for Senior Resource | | | | assurance that the internal system is solid. It must be |
| Group. | | | | repeatable, and must be repeated consistently time |
| To keep a handle on poly-pharmacy, assisted living | | | | after time. |
| communities implement a range of protocols, | | | | Some add a further step: Ongoing auditing. It's just |
| according to a survey conducted recently for the | | | | one more way to ensure accuracy, says Patricia |
| Center for Excellence in Assisted Living (CEAL). The | | | | Foran, president of C.O.R. Services, a consultancy to |
| survey found that 74 percent of assisted living | | | | the senior housing industry. |
| providers make sure doctors or registered nurses | | | | Foran has been on the front lines, having served as a |
| review lab data for residents; 68 percent use | | | | vice president at Benchmark Assisted Living prior to |
| consultant pharmacists, and 67 percent use blister | | | | becoming a consultant to multiple assistant living |
| cards or pillow packs from primary pharmacies. This | | | | communities. Looking at the situation from all sides, |
| type of packaging is a safeguard to ensure residents | | | | she says auditing is a significant tool in keeping errors |
| receive correct medication dosage. | | | | in check. |
| Transitions also may be an issue, a time when drugs | | | | Given the possibility of human error, "you need to |
| or orders can get mishandled on their way to the | | | | have somebody to physically monitor what is going |
| assisted living community. "The biggest problem we | | | | on," she says. In Virginia and elsewhere, the |
| have found is when a resident is transferred [into | | | | executive director has to be certified in medication |
| assisted living]," says Loretta Kaes, RN , vice | | | | management, so there's a built-in auditor. Outside |
| president of health services for Chelsea Senior Living. | | | | consultants also can play that role. |
| Safeguards begin with a vigilant nursing staff, Kaes | | | | In a typical audit, "we are literally asking people to go |
| says. "I want the nurses to question the orders. If | | | | on a med pass, and watching how the practice is |
| you see a resident on 23 medications, I want the | | | | being performed. Then you finetune it each time," |
| nurse to ask which of these drugs possibly are | | | | Foran says. "You need to do this no less than |
| overmedicating," she says. Nurses likewise make it a | | | | quarterly." |
| point to reconcile the medications as delivered against | | | | For Further Assistance... |
| those as prescribed. | | | | In the best examples, assisted living residences have |
| New models also are emerging. Kaes has served with | | | | looked beyond their own internal resources, getting |
| the Health Care Association of New Jersey, which | | | | families involved for cooperative efforts in such |
| has developed an even more streamlined system. | | | | realms as co-pays and drug availability. |
| The group has urged doctors to communicate | | | | "I think the families have to be really aware that their |
| directly with pharmacies, reducing the possibility of | | | | family member is in a plan that covers all their drugs," |
| error and saving the nurse one step. "Otherwise, you | | | | says Jody Silva Falk, vice president of client services |
| spend 18 hours a day trying to chase the doctor | | | | at Chem Rx, a pharmacy serving about 30 assisted |
| down" in search of clarification, Kaes says. | | | | living residences. "They need to know their formulary |
| Rise of the Med Tech | | | | changes every year and they need to stay on top |
| One of the most promising, and most effective, | | | | of that. They need to take a proactive role in what's |
| evolutions in medication management has been the | | | | going on with mom's coverage." |
| rise of the medication technician, or med tech for | | | | In addition to family participation, combined with |
| short. Also known as trained, unlicensed assistive | | | | skillful management of the human elements within the |
| personnel (UAP), these individuals are authorized to | | | | community, technological aids can simplify and |
| deliver medications, freeing nurses to pursue other | | | | safeguard various tasks on the way from |
| tasks. The use of UAPs is allowed in virtually every | | | | prescription to administration. |
| state. These valuable personnel are enabled to do a | | | | Automated medication dispensing carts secure |
| variety of tasks depending on the state, and are | | | | medications and track dosing regardless of where the |
| required to attain certain types and levels of training, | | | | resident may be at the time. |
| again varying by state. | | | | Web-based prescribing facilitates the electronic |
| In the realm of medication management, "UAPs | | | | creation and transmission of orders from desktop to |
| generally do remarkably well with this complex task. | | | | pharmacy. Multi-alarm reminders and watches alert |
| The bulk of the medications are low risk and routine, | | | | users when it's time to take medications. Multi-alarm |
| and the risks appear to be minimal," Young writes. | | | | pill boxes likewise deliver an alarm while also storing |
| While some states are questioning the use of UAPs, | | | | pills. |
| a growing body of evidence suggests med techs are | | | | Automated crushers and splitters ease dosing by |
| an effective means for assisted living to maintain its | | | | reducing pills to the appropriate size. |
| high level of medical management assurance. "Where | | | | In barcoded medication administration, a handheld |
| it is allowed, which is in most states, it is working | | | | device is used to scan a barcode on the resident's |
| very effectively," Bersani says. | | | | wristband ID and match it against coding on the |
| Success lies in training, not merely an introduction to | | | | package of the medication to be dispensed. |
| "how" things are done, but also a view toward why. | | | | RFID (radio frequency identification) assists with |
| "These are intelligent people, you can't just teach | | | | accurate medication tracking and inventory |
| them a task. You teach them the rationale behind | | | | management. "[Electronic medication management |
| things, and that is when you see an increase in | | | | tools] can be a real help if, internally, you have a |
| performance," Flores says. With an understanding of | | | | good computerized system already in place-if you |
| not just how but why, "people are much more | | | | have electronic file maintenance and other internal |
| understanding of proper dosing, proper timing, and so | | | | systems," says Silva K.M. Gerety, corporate director |
| on." | | | | of health and wellness at Brightview Senior Living. |
| To ensure information sticks, Flores issues hands-on | | | | No one would say medication management is a walk |
| testing in multiple topics. The student also must make | | | | in the park. Certainly, there are potential challenges |
| three perfect passes under supervision before being | | | | with polypharmacy, human error, and the long chain |
| allowed to fly solo. Delivering training throughout this | | | | of involvement from doctor to pharmacy to nurses |
| nationwide organization relies in part on quarterly | | | | or assistant. Yet assisted living continues to |
| webinars, which Flores creates. | | | | demonstrate its ability to rise to the challenge. |
| One more winning strategy for utilizing med techs: | | | | "People who come to assisted living generally are |
| Dress the part. Many will think it is a small point, but | | | | getting their medication the way they are supposed |
| Flores insists that uniforms for medication aids lead | | | | to, on time, in the right dose. This is a huge benefit |
| directly to fewer errors. "They are recognized as | | | | to our residents," Kaes says. |
| being something special, and so they act like | | | | |