Anticoagulants are common medications in the PACE environment and are used to prevent blood clots from forming in the body. Popularly known as “blood thinners,” these medications require serious scrutiny from medical personnel when making decisions about care and other medications for PACE participants. Normally, blood clotting is an essential function of the body to protect itself against excessive bleeding in the event of an injury. In other circumstances, though, blood clots can become a dangerous threat to health and well-being if they travel through the blood vessels to the heart, lungs, or brain. Therefore, anticoagulants are typically used in the PACE environment for participants who suffer from:

Also, participants in the PACE environment who have had a synthetic heart valve implanted or received knee or hip replacement are generally on some form of anticoagulant. Let’s take a look at how and why anticoagulants are used within the PACE environment—and examine the risks and benefits.

The Role of Anticoagulants in the PACE Environment

Every year in the United States, approximately 900,000 people suffer a pulmonary embolism or deep vein thrombosis, resulting in 100,000 deaths. At least 25 percent of individuals who suffer a pulmonary embolism die suddenly without any warning symptoms. Men and women who are at a higher risk for blood clots include those who have atherosclerosis, diabetes, heart failure, irregular heart rates, immobility, obesity, and malignancy. Prescribing anticoagulants following an initial blood clot is vital, considering 30 percent of those who have a blood clot will have another clotting incident within ten years. Half of blood clots occur during or soon after surgery or a hospital stay. Many within the PACE environment display one or more risk factors for forming blood clots. [Tweet “#Anticoagulant use is common in the #PACE environment, but it requires some careful considerations.”]

Anticoagulants in the PACE Environment

Although anticoagulants are commonly called “blood thinners,” they do not make the blood thinner. They serve a dual purpose of:

Anticoagulants defeat blood clots by reducing the blood’s ability to clot, either by inhibiting vitamin K or by stopping other clotting factors from operating.

While this is good news for eliminating clots or reducing their risk, it raises the risk of prolonged bleeding should a person suffer a cut or nick. This is the primary risk and unwanted side effect of anticoagulants.

Anticoagulants are available as either oral or injectable products. Oral medications are generally used for ongoing prophylaxis in the outpatient setting for easier administration.

A benefit of the new oral therapies in the PACE environment is they do not require routine blood monitoring. Injectable products are typically used more at the beginning of therapy, especially when treating an existing clot.

In recent years, several new oral anticoagulation therapies were approved by the FDA—Eliquis® (apixaban), Pradaxa® (dabigatran), Savaysa® (edoxaban), and Xarelto® (rivaroxaban). These anticoagulants defeat blood clots by inhibiting thrombin (Pradaxa) or factor Xa (Eliquis, Savaysa, and Xarelto).

The above medications are short-acting compared to warfarin (Coumadin®). So, if therapy is missed, interrupted, or irregular, there is a risk for breakthrough strokes.

If regular therapy is a concern, these medications may not be the best option within the PACE environment, and warfarin may be the likely anticoagulant of choice.

As mentioned above, while the desired results of anticoagulants are admirable and desired, the most undesirable effect is an increased risk for prolonged bleeding. While administering vitamin K has a reversing effect for the anticoagulant warfarin, others do not have reversing agents.

An interest certainly exists for developing reversal agents for the other mentioned products, but none are available at this time.

When switching to warfarin from Eliquis, Pradaxa, Savysa, or Xarelto, those in the PACE environment will need to continue current anticoagulant therapy in addition to the warfarin until their INR reaches effective levels. This should take about five days.

With Pradaxa, medical professionals recommend stopping therapy after one to two days on warfarin, so long as renal function is normal. If renal function is impaired, wait until day three to stop administering Pradaxa.

PACE participants have unique and specialized needs. Our Grane Rx team of geriatric-specialized pharmacists understands those challenges and works with PACE centers to overcome them. Partner with us today by calling (412) 449-0504.

flu complications among elderly adults cost a staggering $56 billion. Adults who are 65 and older, including PACE participants, are at a higher risk for encountering complications from the flu virus. This is especially true for those with underlying health conditions. The enormous clinical and economic burden from influenza outbreaks has long motivated vaccine manufacturers to invest in developing an improved annual flu vaccine for senior adults. One vaccine, licensed in the United States in 2009, and known as the trivalent inactivated influenza vaccine Fluzone High-Dose, has demonstrated better efficacy and effectiveness compared with standard-dose influenza vaccines in older adults. [Tweet “Is the high-dose #fluvaccine really better for #PACE participants?”]

Is the High-dose Flu Vaccine Effective for PACE Participants?

A randomized, controlled FIM12 study proved the overall effectiveness of the high-dose flu vaccine. In this study, 31,989 participants were enrolled from 126 research centers in Canada and the United States.
According to this study, among those 65 years or older, Fluzone High-Dose provided better protection and induced significantly higher antibody responses against laboratory-confirmed influenza than Fluzone Standard-Dose.

Investigators from the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, and the U.S. Food and Drug Administration reported that the high-dose vaccine was 22 percent more effective than the standard-dose vaccine for the prevention of probable influenza.

It was also 22 percent more effective in preventing flu-related emergency room visits and hospital admissions, both important factors among PACE participants.

What About the Cost of the High-dose Flu Vaccine for PACE Participants?

A critical health question for senior adults—and PACE centers—is the cost-effectiveness of the high-dose flu vaccine. Could the vaccine reduce the significant economic burden of flu outbreaks in adults older than age 65?
In one study of cost analysis, the high-dose trivalent inactivated flu vaccine is a cost-saving alternative to the standard-dose vaccine. Moreover, the additional cost of administering a high-dose instead of a standard-dose vaccine produced a staggering 587 percent financial benefit to the healthcare system.

The majority of those savings came through reductions in cardiorespiratory hospital admissions related to the flu. The study results indicate that the high-dose vaccine saved costs over the analyzed two-year period, and therefore showed better cost-effectiveness than most other strategies used.

Although initial costs for the high-dose flu vaccine are higher than the standard-dose vaccine, results of cost analyses favor the high-dose vaccine, mainly because of the reduction of hospital admissions.

PACE providers must focus on patient-centered care while considering the well-being of the participant and the cost savings when recommending immunizations during flu season.

Seniors, including PACE participants, have unique and specialized needs. Our Grane Rx team of geriatric-specialized pharmacists understands those challenges and works with PACE centers to overcome them. Partner with us today by calling (412) 449-0504.]]>

Participants, family members, and providers in the PACE environment should all be familiar with medications and medical conditions that increase the risk of falls. Medications—and their side effects—are one of the major causes of falls in the elderly. Because of the potential for injury when an older person falls, everyone in the PACE environment should be aware of which medications or conditions come with an increased risk of falls. When it’s possible, providers should seek safer alternative medications or even reduce medications to the lowest effective dose as a fall prevention strategy.

Medication Criteria in the PACE Environment

For more than 20 years, the American Geriatrics Society has provided a continuously updated resource for providers to improve the safety of older adults who take medications. The BEERS Criteria for Potentially Inappropriate Medication is the gold standard for prescribing safe medications for older adults in the PACE environment. As PACE participants grow older, their bodies change. Because of these body changes, older adults have a higher risk of unintended or exaggerated side effects from their medications. Each year, one out of three seniors aged 65 or older encounters at least one adverse medication reaction. While the BEERS Criteria is a valuable tool, it cannot be the only guide when prescribing medications for participants in the PACE environment. Different participants respond differently to the same medications. Experienced clinical judgement must be included in every prescription choice. [Tweet “Do you know what medications and medical conditions increase fall risk in the #PACE environment?”]

Anticholinergic Medications in the PACE Environment

Anticholinergic medications inhibit certain nerve impulses, thereby reducing spasms of smooth muscles like those found in the bladder. These drugs are used commonly among senior adults in the PACE environment. Some medications, such as atropine, benztropine, and oxybutynin, are used specifically for their anticholinergic properties, and others such as diphenhydramine, cyclobenzaprine, and olanzapine have anticholinergic properties unrelated to their primary use. Studies have shown that medications with anticholinergic properties can have adverse side effects like blurred vision, dry mouth, urinary retention, constipation, cognitive impairment, confusion, delirium, increased heart rate, and drowsiness. These conditions can significantly increase the risk of falls. The risk of falls increases when taking medications with strong anticholinergic properties, taking higher doses of these medications, or taking a combination of them. Adults in the PACE environment are also more likely to experience adverse events from anticholinergic medications because of bodily changes and preexisting conditions. When possible, medications with anticholinergic properties should be avoided in older adults unless they are absolutely necessary. If the medication is necessary, it should be used at the lowest dose for the shortest possible time. Providers in the PACE environment should also consider replacing such medications with alternatives, including non-medicinal solutions.

Falls in the PACE Environment

It may be impossible to eliminate falls altogether, but everyone should be concerned with reducing the risk of falls throughout the PACE environment. When a fall occurs, it is vital to evaluate the participant’s medications and determine what may have contributed to the fall. For example, if a participant recently suffered a fall, look through recent records and see if a medication dose has been increased, a new medication has been added, or if the participant has been requesting more of a medication that could contribute to a fall. By constantly reviewing each participant’s therapies, talking with family members, and creating action plans when a fall occurs, everyone concerned with the PACE environment can provide participants with the best care possible. Want to learn more about the impact Grane Rx can have on your PACE center and your services in the PACE environment? Start the conversation by calling (412) 449-0504 or emailing paceteam@granerx.com.]]>

The ultimate goal of PACE, including PACE pharmacy, is to provide members of the PACE population with high-quality care that keeps them independent and active, allowing them to remain in the home while receiving the services they need. An essential element of such services is medication reconciliation.

Medication Changes in the PACE Population

Older adults are often on multiple medications—and these medications are often stopped and new medications ordered, as medications are changed over time. Medication changes can cause confusion for members of the PACE population, for caregivers, and for participants’ family members. Lack of communication between PACE participants and healthcare providers during care transitions contributes significantly to medication safety errors. That’s why it’s vitally important for PACE pharmacy providers and other members of the multidisciplinary team to thoroughly review these changes with participants and their caregivers, ensuring they understand what is happening and why.

Reconciling Medications in the PACE Population

With an increased number of medications—which are often prescribed by multiple physicians, including specialists—comes an increased number of potential problems. Side effects, possible duplicate therapies, and the possibility of drug interactions are just some of the serious issues that can arise.

Clinical consults play an important role in ensuring safety among the PACE population. These consults, in which a geriatric-specialized pharmacist reviews participant medications on a regular basis, include a number of safety checks, including:

  • PACE medication regimen reviews
  • Reviews following a clinical change of status or emergency room visit
  • Elimination of duplicate medications
  • Identification of potential drug-drug interactions

Clinical consults serve a dual purpose: They help promote positive outcomes for members of the PACE population, while helping PACE centers contain costs and make efficient decisions.

Coordination of Care in the PACE Population

Communication and participant/caregiver engagement are essential to ensure all parties are working from the same plan. PACE pharmacy services work along with all members of the participant’s multidisciplinary medical team to ensure continuity of care.  

This integrated model of care aims to improve the quality of life of participants within the PACE population with chronic care needs by providing necessary medical and pharmacy services, including medication reconciliation.

Medication reconciliation, part of the clinical consult, carefully reviews a participant’s medication regimen, lowering the risk of preventable medication errors and potential hospitalization.

Literacy Education and Labeling Options for the PACE Population

Health literacy education is designed to ensure each participant understands his or her therapies—taking into consideration hearing, vision, or physical impairments; language barriers; and/or the ability to understand written text.

Optimal, effective medication management for the PACE population utilizes both written and visual tools, along with health literacy information, to help participants and their family members understand their medication regimens.

Grane Rx partners with PACE centers to provide participants with medications that are delivered directly to the home in easy-to-understand packaging that includes clear directions on when medications should be taken. The packaging also includes both visual and written cues on what medications are for, as well as how they should be taken.

These tools, in combination with medication reconciliation, help limit the risk of avoidable drug errors and other potential problems.

Want to learn more about the impact Grane Rx can have on your PACE center and your services to the PACE population? Start the conversation by calling (412) 449-0504 or emailing paceteam@granerx.com.]]>

incidence of constipation is higher in older populations when compared to younger populations. And it’s even more common in older women.
While constipation is not considered a natural consequence of aging, the PACE population is affected by age-related physiologic changes that may contribute to constipation.
Some of these changes include:

The good news, though, is that through both non-pharmacological and pharmacological treatments, PACE pharmacy providers can help older adults belonging to the PACE population get a handle on constipation.

Non-Pharmacological Options for Treating Constipation in the PACE Population

While there are various prescription and over-the-counter medications that are effective in relieving constipation symptoms, there are also a number of non-medication options that can help.

Many of these options can be used with medications to improve constipation symptoms in PACE participants. However, before employing a pharmacological treatment option, it’s worth trying the following non-pharmacologic ones:

Pharmacological Options for Treating Constipation in the PACE Population

Of course, there are pharmacologic options available to help manage constipation. Various laxatives and prokinetic agents are often used to treat constipation, including in the PACE population.

Bulk laxatives, which includes Methylcellulose, Polycarbophil, and Psyllium, work by absorbing water from the intestinal lumen to increase stool mass and soften stool consistency.
Because it can take anywhere from 12 hours to three days for bulk-forming laxatives to work, they are not recommended for the immediate relief of constipation.

Emollient laxatives or stool softeners, such as Docusate, work by allowing water to enter the bowel more readily.
These laxatives are generally well-tolerated, but are not as effective as psyllium in the treatment of constipation.
It’s important to note that in chronically ill older adults, stool softeners are not considered effective, as they generally take between 12 and 72 hours to work.

And finally, though mineral oil is a common go-to for chronic constipation, it’s not a recommended treatment. Experts have noted a severe complication of this medication—the risk of aspiration—and emphasize the importance of heightened awareness among caregivers and post-acute pharmacy providers regarding the potential dangers of inappropriate mineral oil use.

Osmotic laxatives, such as Lactulose, Magnesium Citrate, and Sorbitol, help alleviate constipation by causing water to secrete into the intestinal lumen via osmotic activity.

This class of laxatives tends to show effectiveness roughly one to two days following administration.

It’s important to note that these laxatives should be used carefully among adults in the PACE population who have congestive heart failure and chronic renal insufficiency.

Stimulant laxatives, like Senna and Bisacodyl, work by boosting intestinal motility and water secretion into the bowel.

This class of laxatives generally produces bowel movements within hours, but may cause abdominal cramping because of the increased peristalsis. Typically, stimulant laxatives take between six and 12 hours to work.
In adults belonging to the PACE population, a combination of senna and bulk laxative has shown to be more effective than lactulose in improving stool frequency and consistency. In addition, stimulant laxatives can be used on an as-needed basis, so long as participants carefully follow the manufacturer’s instructions.

Prokinetic agents, which include medications like Tegaserod and Misoprostol, have been studied for the treatment of slow transit constipation—though they haven’t been approved by the U.S. Food and Drug Administration for this indication.

Larger trials are needed to confirm the efficacy and safety of the long-term use for chronic constipation. To date, Tegaserod, in particular, has shown to not improve older adults’ symptoms of abdominal pain/discomfort, even though it increases bowel movements.

Evaluating Pharmacological Options for the Treatment of Constipation in the PACE Population

If a PACE participant is started on one of medications discussed in this article, it is extremely important to continually monitor him or her for the continuation or relief of symptoms.

Additionally, it is recommended to monitor for diarrhea and/or increased bowel movements, which may lead to needing to discontinue medication use.

Though helpful in alleviating constipation symptoms in older adults, laxatives are a drug class that may be potentially unnecessary after period of time. These agents tend to stay on participants’ medication lists for longer periods of time than may be clinically necessary, and there are potential harms associated with long-term laxative use, including:

Because of the risk of long-term harm, it’s essential to reassess the need for laxatives once the participant’s symptoms of constipation are alleviated.
By properly following treatment guidelines, together we can work to minimize the recurrence and symptoms of constipation in PACE participants.

Those in the PACE population have unique medical needs. Our Grane Rx team of geriatric-specialized pharmacists understands those challenges and works with PACE centers to overcome them. Partner with us today by calling (412) 449-0504 or emailing paceteam@granerx.com.

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 paceteam@granerx.com. ]]>

According to the National PACE Association, nearly half of PACE participants have been diagnosed with dementia. Yet, even with the challenges of dementia, they’re living on their own with the help of caregivers. What is the role of PACE pharmacy services in helping manage dementia and mitigate its side effects to the largest extent possible? PACE medication management for participants with dementia must be multifaceted to meet the unique challenges the participants and their caregivers face. Care for these participants must include educational components, enhanced medication safety and regular medication therapy reviews. Here’s a look at the medication-related challenges dementia presents.

PACE Pharmacy Services Challenge 1: Agitation and Aggression

Agitation and/or aggression are common among participants with dementia, impacting up to 80 percent of participants. These behavioral issues can be caused by the disease itself or the medications necessary to manage the condition. In the past, antipsychotics were typically utilized to treat agitation and aggression. However, the negatives of treatment with antipsychotics often outweighed the positives. While their behavioral issues might lessen, patients treated with antipsychotics were at an increased risk of falls and associated mortality. The Centers for Medicare & Medicaid Services’ goal to decrease antipsychotic use by 30 percent in long term care facilities has resulted in a significant reduction in such treatment. During the effort to reduce use, CMS is studying the effects of reduced antipsychotic use, both positive and negative. Among its findings: The use of sedative/hypnotic medications has increased, which means that many patients are still receiving chemical treatment. An alternative method of treating agitation and aggression helps avoid chemical restraints altogether. Studies have found that treating these behavioral issues with pain medications, such as acetaminophen or low-dose morphine, is effective and doesn’t have the associated negative effects. PACE pharmacy service providers play a key role in this shift, monitoring prescriber ordering habits and making expert suggestions on how to best handle behavioral issues. [Tweet “Caring for participants with #dementia presents unique challenges for #PACEpharmacy”]

PACE Pharmacy Services Challenge 2: Enhanced Medication Safety Needs

Participants with dementia face a number of safety concerns related to activities of daily living, including medication use. PACE pharmacy providers are challenged to help mitigate those concerns as much as possible. For one, as dementia progresses, many participants will experience dysphagia, making it more difficult to swallow. Pharmacists and other clinicians will need to keep a careful eye on swallowing abilities, and switch participants to liquid medications when needed. Because caregivers will play an increasingly significant role as dementia worsens, the educational component of PACE pharmacy is magnified. This calls for more interaction with family members and other caregivers to help ensure they understand how to give medications correctly. This will include discussion of the need to provide participants with clear instructions on how to take/swallow the medication, what to do if a participant refuses to take a medication and the need to place medication in an inaccessible location. Part of this educational component is required to counteract advice given by national dementia organizations. Many recommend that caregivers place a participant’s medications in a dayminder for easy distribution. But research indicates that dayminders, also known as pill organizers, are not the most effective method of distribution, and can, in fact, be dangerous. Grane Rx’s EasyRead Pharmacy Solution and SimplePack technology provide a more appropriate method of distribution that achieves the same purposes while negating the potential safety issues.

PACE Pharmacy Services Challenge 3: Potential Drug Interactions

Many participants with dementia are affected by polypharmacy due to the large number of medications they take to treat both the dementia and comorbidities. This places them at a higher risk of drug interactions. Drug interactions are particularly common when a participant takes both a cognitive enhancer and an antipsychotic to treat the symptoms of dementia. This particular concern was mentioned above. However, other interactions do frequently occur in this population. A study published earlier this year found that severe potential drug interactions were most likely in dementia patients treated with antidepressants, antiplatelets, antipsychotics and omeprazole. Because of the likelihood of drug interactions, medication reviews take on increased importance. Participants with dementia are also more prone to experience side effects from medications. Along with looking for potential drug interactions, PACE pharmacy providers should also ascertain from clinicians and caregivers whether any negative effects are experienced and seek to adjust medication regimens accordingly. Grane Rx’s PACE pharmacy team understands the unique challenges of dementia care. Learn how we can help your PACE team by calling (412) 449-0504 or emailing paceteam@granerx.com.]]>

By Jennifer Devinney, RPh, PharmD Polypharmacy is an often silent, but very serious, problem in PACE pharmacy today. It is defined as the administration of more medication than is clinically indicated, which represents unnecessary medication use. Thorough PACE medication management is key to limiting polypharmacy. Polypharmacy is especially prevalent in elder care where it has been estimated that approximately a quarter of patients are prescribed nine or more medications, with some studies showing much higher percentages of patients exceeding five, nine or ten medications.

Defining Necessity

For a medication to be considered necessary, it should be prescribed with a clear diagnosis that is supported by practice guidelines, clinical research or standards of care at a dose, duration, frequency and route of administration in concurrence with these guidelines. Additionally, medications should be used at the lowest effective dose for the shortest duration possible, avoiding duplication of therapy with other agents. The medication should be monitored according to practice guidelines, including periodic lab levels as well as clinical monitoring for therapeutic response and the development of adverse effects. When prescribing a medication, definitive therapeutic goals should be established in addition to the indication for use. Having clear therapeutic goals is vital in order to appropriately assess whether a medication is beneficial as therapy progresses. It also enables the healthcare team to create a larger and more comprehensive care plan for the participant. [Tweet “With seniors taking multiple medications, #polypharmacy is a growing concern in #PACEpharmacy”]

The Role of Medication Review

A thorough medication review when a participant is accepted is one of the most important PACE pharmacy practices to help eliminate unnecessary medications. It’s important to determine why a participant is using a particular medication and to match each medication to an appropriate diagnosis. Often, medications are associated with a general diagnosis, no diagnosis or a diagnosis that is not an FDA-approved indication. In these cases, clinical judgment should be utilized to determine whether the off-label use is appropriately supported based upon the participant’s medical history and if the benefits of therapy outweigh the risks of adverse effects. The psychotropic medication class, which includes antipsychotics, anxiolytics and sedative/hypnotics, is one of the highest risk medication classes for the geriatric population. The risk of adverse events, including increased mortality, is very high in the elderly—making the risk versus benefit line with psychotropic medications extremely tenuous. When psychotropic medications are used outside of their FDA-approved indications, the literature supporting their use is lacking. In fact, most literature does not recommend off-label use due to lack of positive outcomes. Due to inherent risks, psychoactive medications need to have a clear goal of therapy, which includes specific target behaviors that support the use of the medication. Adverse effect monitoring is extremely important for this class since these medications carry substantial risks, and periodic dose reductions are necessary to provide evidence that the lowest effective dose is being utilized. Optimizing medication regimens when more than one agent is being used to treat a condition is another important practice for preventing polypharmacy. The most prevalent example of this would be using multiple agents to manage hypertension. It’s not uncommon to see as many as four or five antihypertensive medications ordered for the same participant. One of the fundamental guidelines in treating a disease state that may require more than one medication is to start with one medication and maximize the dose until either the maximum recommended dose is reached or the maximum dose without adverse effects is reached. After the maximum dose is reached, then another agent can be added and titrated if better control is needed. participants on multiple medications at suboptimal doses should have their regimen evaluated and, if clinically acceptable, have a medication discontinued while adjusting the doses of the other medications.

Drug Classes of Particular Concern

Proton pump inhibitors (PPIs) are one of the most commonly prescribed unnecessary medications. PPIs are frequently utilized for treatment of GERD in the elderly. Practice guidelines recommend treating GERD initially with PPIs for eight to 12 weeks and then evaluating whether the GERD has improved. Often, the evaluation does not occur and many participants will remain on PPIs for years without any dose reductions to see if the dose or medication is still needed. Long term use of PPIs increases the risk of certain complications, such as osteoporosis and clostridium difficile infection. Allergy medications prescribed for long term chronic use are another commonly seen unnecessary medication. Many times allergy symptoms such as runny nose and itchy eyes are often seasonal or otherwise short-lived, yet the participant is ordered a long term scheduled dose of an antihistamine medication. It’s important to periodically evaluate whether these medications are still necessary since they have adverse effects such as drowsiness. Trial, as-needed orders are a good way to check whether this type of medication is still necessary. Some other more commonly seen unnecessary medications include:

Limiting Polypharmacy in PACE Pharmacy

One of our consistent clinical goals in the PACE pharmacy solutions we offer is to assist our partners in reducing unnecessary medication orders per participant by ensuring that each medication has a clear purpose, is meeting clinical goals and is necessary to maintain the overall well-being of that participant. Reports that outline the numbers of scheduled and PRN medications each participant is ordered are available to assist with these efforts and to trend progress. Our goal is to help reduce polypharmacy and the potential dangers associated with it, while optimizing medication administration and pharmaceutical spending.]]>

When compared with long term care pharmacy, PACE pharmacy presents its own unique set of challenges. Because participants are in the home environment rather than in a long term care setting with clinicians on hand, questions, concerns and needs may arise at any hour of the day. That’s why around-the-clock PACE pharmacy staffing is vital. Having PACE pharmacy providers available 24 hours a day, seven days a week means that there’s always a geriatric pharmacy expert on hand who can help PACE center staff meet participant needs. This allows for a smoother process for PACE medication management. So what are the distinct advantages of having around-the-clock PACE pharmacy staffing for your PACE center? There are three main benefits.

Benefit 1: PACE Pharmacy Providers Can Answer Clinician Questions

There are many scenarios in which questions arise related to PACE participants and their medication regimens. When a provider is preparing to prescribe a new medication, he or she may have questions about what medications are in stock or what medications are on the preferred list. Or someone on the PACE center staff may need clarification in order to answer a question posed by a PACE participant or caregiver about a medication regimen. That’s where Grane Rx’s commitment to 24/7 PACE pharmacy staffing makes an impact. Whether during the day or in the middle of the night, a certified geriatric pharmacist is available to answer questions promptly either by phone or through the EHR system, making the process of medication dispensing more seamless. And when participants and their caregivers fully understand their medication regimens, they’re more likely to adhere to them. [Tweet “Around-the-clock staffing for #PACEpharmacy services benefits participants and staff”]

Benefit 2: PACE Pharmacy Providers Can Make Adjustments to Medication Regimens

Sometimes changes to a participant’s medication regimen can’t wait until standard business hours. If medications have been added to a participant’s regimen and the participant begins to experience side effects, Grane Rx PharmDs are available to perform a medication review. During this review, the pharmacist can help determine what medication or interaction could be causing the effects, as well as make suggestions to a provider about an appropriate alternative medication. This benefit is especially important when a PACE participant is first admitted and begins working with PACE center staff. As PACE medications are initially prescribed, there’s typically a need for adjustment. Having PACE pharmacy providers available 24 hours a day allows for those adjustments to be made quickly and efficiently.

Benefit 3: PACE Pharmacy Providers Can Promptly Fill Emergent Prescriptions

The final benefit may in fact be the most significant. When a PACE participant has emergency medical needs, such as that for an illness or injury, he or she needs medication promptly. With Grane Rx’s around-the-clock PACE pharmacy staffing, participants have quick access to medications when they need it most. This prompt access allows participants, for example, to begin antibiotic or antiviral regimens quickly, which begins the process of limiting an illness’ effects. The sooner a participant can begin taking medication for an emergent need the better, making 24/7 access to PACE pharmacy services essential. Our commitment to 24/7 staffing is just one part of Grane Rx’s approach to PACE pharmacy services. Make the transition to Grane Rx today by calling (866) 824-MEDS (6337).]]>

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.]]>