QUALITY IMPROVEMENT
Recognizing the Complexities of Medication Management for Seniors
By Debbie Reslock O
verseeing prescription use can be a challenge for anyone. Each year more than two-thirds of primary
care office visits result in drug therapy, totaling 3.7 billion medications ordered or provided, according to the Centers for Disease Control and Prevention. But when it comes to senior residents, the bar is set even higher. “They’re often being treated for multiple conditions, have more than one doctor, more than one pharmacy, and may also self-medicate,” said Melissa Deas, president of Guardian Phar- macy of Dallas-Ft. Worth, which provides full pharmaceutical services to assisted living, skilled nursing, and other living environments. The increased number of adverse drug
events for older adults directly correlates with the fact that they take more prescriptions and over-the-counter drugs, said James Baumeister, director of pharmacy systems at ECP, a soft- ware solutions company which offers eMAR, EHR, and assessment tools. “When we’re younger, effects like drowsiness and dizziness are more manageable because they’re not typically magnified by other prescriptions.” But as we get older, the function of organs
that filter waste declines and the more med- ications taken at the same time escalate the risk of drug to drug interactions, said Labinot Avdiu, Pharm.D., F.A.C.A., CEO/partner of Medication Management Partners, a phar- macy solutions company. “Those taking two drugs have a 13 percent increase, five drugs raise the percentage to 58, and seven or more result in 82 percent. When you look at the senior living population, the majority of resi- dents are at least a 60 percent risk.”
Senior communities and the challenges of medication management Two populations often at higher risk are those being discharged from the hospital to
40 SENIOR LIVING EXECUTIVE JULY/AUGUST 2018 The ECP App, allowing for online and offline charting.
rehab and seniors who live in CCRCs, assist- ed living, and independent living communi- ties. The first group may be leaving the hos- pital on much more medication than they’ve taken before, said Chad Worz, Pharm.D., executive director and CEO for the Ameri- can Society of Consultant Pharmacists. The second group resides where regulations and training on medication management varies. “We need a holistic view,” said Worz. The workload is heavy at assisted living
communities, Baumeister said. In addition to their other responsibilities, they’re often expected to administer hundreds of med- ications on schedule, maintain accurate records, and help identify adverse events. “When residents move into a community,
many have had years of inappropriate use of medication at home, which can now become the operator’s problem. And if you have 100 residents who each see several doctors or hos- pice, you need to integrate all of that infor- mation with their health records,” Avdiu said.
If there’s no requirement for an RN on-
site, education on medications, adherence, and adverse events is a priority for staff members as well as for those living there. “We have resources for both that include videos of pharmacists explaining medica- tions, why they’re given, and common side effects to look for,” Baumeister said. When a resident leaves the community,
the administration of medication, observa- tion, and charting may no longer be under the oversight of the community, resulting in increased risk. Hospital visits often result in dosage adjustments and prescriptions added or discontinued. Good communication is key between physicians, the pharmacy, and the community to ensure current medica- tion information matches, said Baumeister.
Electronic management and consolidating pharmacy services Whenever humans are involved in a task, the possibility of error is inevitable. But
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