Analyzing Medication Administration Times Moving Forward: Gain Workflow Efficiencies and Resident Safety

While evaluating and optimizing medication administration practices are especially important in the short term to prevent transmission of COVID-19, in the long term, these strategies help make workflow more efficient, medication regimens safer for residents, and prevent the spread of other microbes overall.

Consolidating Medication Administration: To help determine the most efficient strategy in administering medications, analyze the way in which a resident’s medications are currently administered. Look for ways to reduce the number of visits to the resident which require direct or very close contact (such as medication administration), thereby allowing time for other care related tasks or socialization opportunities as well as reducing pill burden for residents.

Flex Time Administration: For medications that do not need to be administered at very specific times, consider switching to a flexible medication administration schedule or the universal medication schedule to minimize the number of medication passes per day. These schedules allow for more flexibility in administration of medications throughout the day for the nursing staff and are generally more resident-friendly.

For example, under the universal medication schedule, the directions “take one tablet twice daily” may become “take one tablet in the morning and one tablet at bedtime”. Medications with directions written according to the universal medication system at a certain time of day can then be given together in one administration time rather than at separate, specific times.

For example, a medication that was originally scheduled to be administered at 10:00 AM and another scheduled to be administered at 9:00 AM can be given at the same time “in the morning”, as long as there are no interactions or restrictions. This reduces the number of medication passes from two to one.

Assess for Unnecessary Medication: As mentioned previously, it is important to actively and continuously work with other healthcare professionals on your team to make sure the resident’s medication regimen does not have any unnecessary medications. Reducing the amount of medications in a resident’s regimen in turn reduces the frequency of administration times.

Eliminating unnecessary medications not only minimizes transmission of microbes, but also minimizes the opportunity for medication interactions and adverse effects. Unnecessary medications may complicate medication regimens and increase pill burden. The more medications in a resident’s regimen, the more chance of a resident experiencing adverse effects and potential medication interactions.

Prevention is an Outcome:  in the older adult population, medication management can go a long way in preventing falls, potential visits to the emergency room, and reducing costs.

The above medication management and administration strategies can help reduce transmission of microbes and allow for efficient and safe medication administration overall. Grane Rx consultant pharmacists can help implement these strategies as they have the ability to analyze your facility medication pass distribution and resident pill burden to help balance and optimize the efficiency of medication administration.

Reduce Transmission of COVID-19. During this emergency, it is important to take all precautions to reduce transmission of COVID-19. While we are actively working to increase infection control practices and maximize physical distancing, as health care professionals, we must continue to provide care for our residents as well as ensure that they are receiving the medications they need. 

Reducing the frequency of medication administration is one additional way to help reduce direct physical contact and potentially reduce transmission of COVID-19. 

Here are some tips for evaluating potential areas of opportunity to impact frequency of medication administration:

In PACE pharmacy, medications are typically dispensed to participants in monthly increments that are either picked up at the PACE center or delivered to the home. But what happens when a participant’s medication regimen needs to change in the middle of a cycle? Because PACE participants usually take multiple medications for a variety of medical conditions, it isn’t uncommon for physicians to switch out a medication or change its dosing. It also isn’t a problem. We’ve created a seamless process designed to handle medication regimen changes when they occur—without compromising participant safety or health. Read on to learn more. Let’s first take a look at the “why” behind our packaging. Medication nonadherence is a significant problem among the senior population and is especially critical for PACE participants. With this in mind, Grane Rx uses innovative packaging called SimplePacks when dispensing PACE pharmacy medications. This packaging is just one part of the overall Grane Rx PACE Pharmacy Solution, which is designed specifically with seniors in mind—featuring clear, understandable information about medications to encourage adherence. Each month, participant’s medications are packaged together inside two color-coded boxes: one for everyday medications and one for medications that are taken as necessary. Within those boxes, medications are packaged in SimplePacks, which are easily opened perforated packs of medications taken at the same time of day, whether morning, noon, evening or at night. This unique PACE pharmacy solution offers a much better medication management system than the bingo cards typically used by long term care pharmacy and other PACE pharmacy providers. The very thing that makes our packaging unique and innovative—our SimplePacks perforated pill packs—can seem like it would be tricky when medication changes are needed. But actually, that isn’t the case. [Tweet “A simple #PACEpharmacy process can make medication changes seamless”]

“Immediate Change” Medications in PACE Pharmacy

The first step in managing medication changes is identifying medications that must be immediately changed. The vast majority of medication changes, including dosage changes, don’t need to be made immediately. Those changes can simply wait until a participant’s medications are dispensed again. Our PACE pharmacy worked with a team of physician and pharmacy experts to compile a list of medications that need to be changed immediately, along with medications that are more subjective in nature. When Grane Rx partners with a new PACE center, we review this list with the center’s medical staff to ensure it aligns with their practices. The center-specific list is adjusted as necessary at that time. Prescriptions identified as immediate change medications are placed in separate SimplePacks and not commingled with other medications. This typically includes certain classes of medications, such as anti-hypertensive drugs, that require periodic adjustments to dosage or to determine which medication works best for a participant. Because these medications are automatically packaged separately from the rest of a participant’s medication regimen, those pill packs can simply be removed and the replacement medication incorporated—at any time. In the case that a new, non-immediate change medication is prescribed for a participant, that medication is packaged as a one-off and then incorporated into the participant’s normal SimplePacks the following month. When it comes to PACE pharmacy services, Grane Rx thinks through all the possibilities and offers the solutions your PACE center needs. Get started today by calling (412) 449-0504 or emailing ]]>

The ultimate goal of PACE is to keep participants healthy and aging in place at home. For PACE pharmacy providers, one significant part of that mission is ensuring participants understand and adhere to their medication regimens. Each year, an estimated 700,000 people visit emergency rooms due to adverse drug events, including medication nonadherence. In many cases, health illiteracy plays a significant role, as patients don’t understand why they’re taking medications or how to take them correctly. That problem is magnified among seniors, with more than two-thirds having basic or less than basic health literacy. Adding to the problem, prescription labels have long been highly variable and inconsistent, with vague and unhelpful directions. Grane Rx offers a number of solutions that work hand-in-hand with UMS, helping PACE participants understand their medications and take them properly. Let’s take a look at three of those PACE pharmacy solutions.

PACE Pharmacy Solution 1: Use of the UMS Medication Dosing Times

The Grane Rx EasyRead Pharmacy Solution dispenses medications in color-coded boxes that indicate whether a medication is taken daily or as needed. The back of the box includes a LearnRx calendar that clearly identifies for PACE participants what time of day each of their medications should be taken. The calendar includes the four UMS medication dosing times—morning, noon, evening and night. In addition, within the boxes, medications are dispensed in perforated SimplePacks with medications grouped together for each of those dosing times.

PACE Pharmacy Solution 2: Icons Drive More Compliance

The last decade has seen a push for a universal medication schedule (UMS), with the goal of providing a more uniform, easily understood way of describing how to take daily medications. The UMS utilizes four specific medication-taking time periods—morning, noon, evening and bedtime—and moves to simplify phrases such as “take one tablet twice daily.” Instead, a prescription adhering to UMS would add clarity by saying “take 1 tablet in the morning and 1 tablet at bedtime.” A Northwestern University study found that participants receiving medications labeled using the UMS were less likely to make mistakes with their medication regimen. The most significant improvement was seen among those with low health literacy and those with complex medication regimens—two common attributes among the PACE population. [Tweet “Improving #medicationadherence requires a thorough approach in #PACEpharmacy”]

PACE Pharmacy Solution 3: Directions for All Types of Learners

We understand that everyone learns and takes in information differently. Our packaging utilizes words, colors, numerals and symbols to provide information in a way that participants will connect with. The UMS dosing times themselves are identified using words, colors and a symbol—for example, morning doses are identified with green and a rooster in addition to the time of day. The packaging is supplemented by LearnRx medication summaries for each medication, providing pertinent information at a fifth-grade reading level and in a larger font that’s easier on participant eyes. These summaries are also available in multiple languages.

PACE Pharmacy Solution 4: Medication Images

Because PACE participants typically take multiple medications for a variety of health conditions, being able to differentiate between medications is essential. Grane Rx packaging includes a photo of each medication tablet or capsule to make identification easy. On the same line with the medication image, participants can see the medication’s name, along with why they’re taking the medication. Including the medication’s therapeutic indication is vitally important, since patients who know why they’re taking a medication are more likely to take it correctly. Once you partner with Grane Rx for PACE pharmacy services, we take it from there. From ordering to packaging to delivery, we provide the solutions your PACE center needs. Get started today by calling (412) 449-0504 or emailing ]]>

The medication packaging used in long term care pharmacy has evolved over the past few decades, with rapid changes occurring just a few years ago. Most LTC pharmacy services providers today utilize medication punch cards to dispense medications to SNF residents or PACE participants. Medication punch cards were first used in the 1970s, when pharmacies began packaging together 30-day or larger supplies of medications. Current usage of punch cards can be traced back to 2009 when the Congressional Budget Office determined that medication waste in long term care would cost Medicare more than $5.5 billion by 2019. As a result of those findings, rules were issued in the next few years mandating that prescription medications in long term care pharmacies be dispensed in no greater than two-week increments. This drive to reduce medication waste led to the advent of punch cards for 7- or 14-day periods, rather than 30-day periods as they were previously. But when it comes to medication management, there’s a better kind of packaging than medication punch cards. Let’s take a look.  

Medication Management: Medication Punch Cards vs. SimplePacks

While punch cards, or bingo cards as they’re sometimes called, seem like a good method of dispensing medications, they can actually make the process quite tedious and cost-prohibitive. For one, punch cards make medication passes less orderly for nurses. They have to search through a stack of punch cards to locate a resident’s medications, which can make it difficult to quickly and accurately find things. With SimplePacks, nurses have more efficient access to medications. Grane Rx technology uses automation to package medications together that are taken at the same time of day, including morning, noon, evening and bedtime, as well as on an as-needed basis. Because the medications are presorted and come packaged in secure, easy-to-separate packets, they make medication passes easier for nurses. These same benefits extend to PACE participants and their caregivers through Grane Rx’s PACE Pharmacy services. PACE participants and caregivers are able to quickly ascertain what medication is needed at a given time, without accessing medications they don’t need. Dispensing medications in SimplePacks also reduces waste. The packs are dispensed in short day supply, 3 days or 4 days, rather than the longer durations typically seen with punch cards, like a 7, 14 or 30 day supply. This short cycle packaging is especially beneficial to the post acute care industry.  When medications are discontinued from a resident’s medication regimen when using punch cards, you could see waste of more than a week’s worth of medication. With SimplePacks, a smaller amount of medication is dispensed, yielding less waste. [Tweet “When it comes to #medicationmanagement, bingo cards aren’t your best option. #LTCpharmacy”]

Medication Management: An Enhanced Layer of Safety

SimplePacks also offer additional layers of security. Only medications that can be taken safely together are packaged together, helping avoid adverse drug interactions. Additionally, Grane Rx offers an added layer of security not offered by many pharmacies.  Before being dispensed, all SimplePacks are sent through imaging technology, which checks for multiple indices, including size, shape and color, among other factors. This process is crucial for accuracy and safety. Finally, for PACE programs and members of our Meds2Home™ program, the packaging itself features both written and visual information, designed for optimal clarity and safety. This includes written details about the medication along with a visual depiction of what the medications look like. These details are paired with EasyRead medication literacy materials that explain the medication’s purpose, dosing and other pertinent information. Interested in learning more about the long term care pharmacy solutions Grane Rx can provide for your Skilled Nursing Facility or PACE program? Call (866) 244-MEDS (6337) or reach out to us here.]]>

By Jennifer Devinney, RPh, PharmD Agitation and aggression in elderly residents with cognitive disorders can be a common occurrence in long term care settings. Recently, there has been research published evaluating the role of untreated or undertreated pain in residents with dementia and the potential impact of proper treatment. Residents with Alzheimer’s disease are reported to have an incidence of agitation approaching 80 percent. Furthermore, agitation and aggression are leading causes of institutionalization in older people with dementia. The source of the agitation or aggression in the residents may not be entirely known; however, what is known is that dementia causes a biological change in an individual, which affects and impairs their ability to process new information and stimuli. As a result, their ability to communicate effectively about what is bothering them is inhibited. When a resident is experiencing agitation or aggression, there are a number of factors that should be evaluated from the environment to daily routines or perhaps most importantly comfort and pain.  

Long term Care Pharmacy for Residents With Dementia: An Evolution of Care

For many years, the primary method to control aggression and agitation in residents with dementia was the use of antipsychotic medications. While antipsychotic therapies may assist with lessening agitation and aggression in some residents, their use is also shown to increase fall risk, as well as negatively impact the overall mortality of residents.   Because agitation and aggressive behaviors themselves lend to an increased risk of falls, injury and hospitalization, it has become a primary focus in long term care to reduce these behaviors while abstaining from utilizing antipsychotics due to their own risk of falls and associated mortality. As a result of the Centers for Medicare & Medicaid Services’ initiative to reduce unnecessary antipsychotic medication use in long term care residents with dementia, antipsychotic utilization rates in skilled nursing facilities have begun to decrease significantly through the adoption of a resident-centered care approach. As the focus has changed to identifying the root cause of behaviors, care teams, including long term care pharmacy providers, are now looking outside of our standard boxes and previous comfort zones. Pain poses its own challenges in residents with cognitive impairment because the gold standard of pain assessment is self-report. If the resident is unable to communicate appropriately, self-report may manifest itself as agitation or aggression. [Tweet “Pain medication been shown to reduce aggression among #dementia patients. #longtermcarepharmacy”]

A Look at the Research

In a recent study, it was found that the treatment of pain in residents with dementia resulted in a 17 percent reduction in agitation and aggression, which is comparatively close to the reduction in the same behavior when an antipsychotic medication was used. Additionally, in the group that received pain treatment, there was documented improvement in overall neuropsychiatric symptoms and pain levels. The stepwise treatment initiated in the study conformed to the American Geriatric Society Panel on the Pharmacological Management of Persistent Pain in Older Persons, where residents taking no analgesics or only low-dose acetaminophen were switched to full-dose acetaminophen with a daily maximum dose of 3,000 milligrams. Residents already on full-dose acetaminophen or low-dose morphine received a maximum dose of 10 milligrams of short-acting morphine twice daily. Residents unable to take oral medications or already on low-dose buprenorphine were placed on transdermal buprenorphine at doses of 5 to 10 micrograms per hour. Finally, those with neuropathic pain received adjuvant pregabalin at doses up to 300 milligrams daily. The outcome, as previously stated, was a 17 percent reduction in the aggressive and agitative disorders seen in dementia. The stepwise therapy results were not due to sedation; as 69 percent of the total population received only acetaminophen. Of the 25 percent receiving opioids, only three stopped therapy due to sedation. A separate study focused on the use of acetaminophen alone in pain treatment for individuals with dementia and aggression or agitation. This study found that with a regularly scheduled acetaminophen treatment—not exceeding 3000 milligrams per day—individuals experienced a decrease in behavioral symptoms of agitation and aggression. In addition, this course of therapy also resulted in a 75 percent discontinuation rate of all psychotropic medications.  

Analyzing Resident Pain in Long term Care Pharmacy

Treatment of pain with acetaminophen may also be a benefit in this population due to the aforementioned communication barrier challenge that is present in cognitively impaired residents. Utilizing a Faces Pain Scale and scheduled acetaminophen dosing has the potential to provide caregivers, including long term care pharmacy providers, with necessary tools to assist with the communication barrier while effectively addressing pain. Barriers to communication are common in residents with dementia, but there are methods to encourage communication in otherwise confused or silent residents. Using slow, simple sentences and patiently waiting for a response can give residents time to comprehend the request, as well as respond in kind. Writing the questions down gives resident the opportunity to physically give an answer instead of verbally doing so. Avoid quizzing or distracting residents as this may increase the display of agitation or aggression. Through consistent and close relationships with residents, caretakers may also develop an understanding of their nonverbal communication of discomfort and pain.  This also can increase the ability to treat pain, thereby avoiding behavioral issues. Pain is a very subjective experience, which can be further complicated by cognitive impairment.  During the assessment and evaluation of behavioral disturbances, such as agitation and aggression, it is also valuable to solicit the feedback of family members and caregivers on prior experience with the resident.   Prior to initiating therapy with an antipsychotic medication, consideration may be given to pain evaluation and non-pharmacological interventions, such as exercise, massage, relaxation, and heat or cold therapy. As shown through these studies, scheduled treatment of pain may reduce agitation and aggression without the utilization of antipsychotic medications, producing a more appropriate outcome for the resident and facility alike. Grane Rx is dedicated to understanding and implementing the latest best practices in long term care pharmacy services. We offer a variety of clinical solutions designed to meet your center’s needs.]]>

Providing optimal care for residents who are at a high risk for hospital readmission is one of the most significant challenges in long term care. While numerous factors place a resident at risk of hospital readmission or experiencing complications, studies have found that the inappropriate use of medication has a profound cost to resident health. A study from the IMS Institute for Healthcare Informatics found that medication mismanagement, including nonadherence, delayed treatment and medication errors, results in 10 million hospital admissions that cost more than $200 billion each year. Of the six areas of medication mismanagement studied, medication nonadherence showed the biggest impact. How can you help improve the care your center is providing at-risk residents, including adherence to prescribed medication regimens? Automated medication dispensing cabinets play a key role.  

Automated Medication Dispensing Cabinets Improve Nurses’ Access to Medications

Automated medication dispensing cabinets store, dispense and track medications at the point of care. Medication access in resident care areas promotes the timely administration of medications while also increasing the amount of time nurses can devote to resident care. Grane Rx SimpleAccess cabinets go a step beyond many other automated medication dispensing cabinets with the Anywhere RN Solution. This web-based application allows nurses to perform medication management tasks away from the SimpleAccess Cabinet. Nurses can also retrieve medications for multiple patients in one trip to the dispensing cabinet, thereby aiding in efficiencies. [Tweet “3 major benefits of #automatedmedicationdispensingcabinets #skilled nursing”]

Automated Medication Dispensing Cabinets Provide Additional Safety Measures

The use of automated medication dispensing cabinets enhances resident safety in multiple ways. With SimpleAccess cabinets, medications are dispensed in resident-specific, multi-dose packaging, which helps largely reduce medication errors. Other safety measures include:  

Automated Medication Dispensing Cabinets Automate and Streamline Documentation

The SimpleAccess Cabinet streamlines the medication data entry process both for inputting medication information and for retrieving it. A pharmacist reviews the medication prescription to check for drug allergies and drug interactions.   Nurses do not need to manually enter resident medication or demographic information into SimpleAccess resident profiles. Information is instead automatically populated using a bidirectional interface from the pharmacy’s information system to the SimpleAccess cabinets. Inventory is also simplified. Grane Rx works with each center’s team and medical director to develop a center-specific medication formulary, which helps ensure the most commonly used medications are available for immediate use. Inventory is also customized based on a Grane Rx review of medication utilization and then approved by the center’s medical director. An additional layer of support is included for controlled medications. Controlled medication records are available immediately, which reduces nursing efforts during shift change processes. Documentation about controlled medication dispensing is also readily available, making it easier to meet federal and state requirements. Grane Rx’s SimpleAccess Cabinets provide a variety of benefits that help lower Skilled Nursing Facility costs while improving care for at-risk patients.]]>

For decades, when people aged and developed chronic medical conditions, they were moved from their homes into a nursing home setting. The advent of the Program of All-inclusive Care for the Elderly (PACE) in 1971 marked a change in that process, allowing many people to age in the comfort of their own home. Today, the ability to obtain comprehensive PACE care, including medications, and remain at home is further evolving long term care.  

PACE: The Future of Long term Care

While the implementation of PACE has been a gradual process over the last several decades, PACE centers represent the future of health care.   Several factors will likely continue to drive an increase in PACE utilization:     [Tweet “The impact of #PACE medications at home on #longtermcare”]

PACE Medications at Home

The average PACE participant has eight acute or chronic medical conditions and needs assistance with at least three activities of daily living. Because of the sheer number of health conditions experienced by this population, medications play a significant role in PACE.   The role of the geriatric pharmacist in delivering PACE medications at home is complex. Before medications are dispensed, pharmacists implement a number of quality assurance and safety processes, including:     After these processes take place, PACE medications can be then be packaged and delivered for use in the home, which helps allow the older population to age at home as long as possible, while still supported by an interdisciplinary team.   Grane Rx partners with PACE centers to provide pharmacy solutions from initial prescription ordering to packaging and delivery of medications. Our PACE pharmacy solution set includes innovative, participant-friendly medication packaging, known as SimplePacks; clear and effective labeling and prescription directions; and 24/7 access to certified geriatric pharmacists.   Grane Rx also takes the quality assurance process one step further — 12 automated security checkpoints are involved in dispensing SimplePacks, helping to reduce the number of medication errors.   Once SimplePacks have been dispensed, they’re delivered to the home of the participant. This program eliminates the need for the clinical staff to manage the medications and provides more time for participant care. Further, this program helps enhance medication compliance and adherence, which will improve outcomes for participants in the program. The usage of PACE medications at home helps strike a balance. While helping improve medication safety and adherence, it also provides the older population the opportunity to age at home, a continuation of the evolution of long term care.]]>

Nursing Home Pharmacy Services Improve Med Adherence Medication adherence means taking the right dose of the right medication at the right time—always. Patients are at risk of problems if they:  

  Grane Rx Meds2Home™ program can help. SimplePacks, prepackaged daily doses help people take the all of the right medications, every day. Multi-checkpoint systems in the packaging process mimic checkpoints in the medication administration process and reduce errors. Clear labeling helps people know what they are taking and how to take it. SimplePacks make safe and effective medication taking easy for people at home.  

Nursing Home Pharmacy Services Provide Oversight

With many elderly people on multiple meds, polypharmacy is a significant risk factor. While polypharmacy itself isn’t a problem, multiple medications increases the risk of medication interactions, missing medications, or taking medication incorrectly.   Pharmacists identify potentially contraindicated medications. They know which medications are of concern in aging bodies that process drugs differently. They also advise on ways to streamline pill load, which is yet another way to help with medication adherence. Grane Rx solutions allow people living at home with simple packaging and easy to read labels. [Tweet “Elderly patients need better #pharmacy services at home”]

Nursing Home Pharmacy Services Reduce Rehospitalization

Better medication adherence and reduced adverse drug events aren’t just numbers. They’re important factors in both quality of life and keeping people healthy at home. Medication mismanagement is the number one reason for hospital readmissions. Having medications delivered home through the Grane Rx Meds2Home program is a big step to reducing reducing medication mismanagement and thus lowering hospital readmissions. Patients don’t have to stop at the local drug store to pick up medications — they often leave the Skilled Nursing Facility with medications in hand. This has a clear impact on the elderly served. It also has a significant impact on managing costs for your center. There are many factors that go into successful outcomes for people living at home. Pharmacy is one of them. Bringing the best of nursing home pharmacy services home can be the difference between staying at home and rehospitalization for the elderly in a PACE program or those needing meds after a stay in a skilled nursing facility.]]>