In the long-term care setting, the fall incidence percentage is severe—almost 50 percent. As SNF residents age, this percentage rises. The incidence rate of falls (number of falls per 100 person years) increases from 47 in older adults ages 70–74 to 121 in those that reach age 80.
It’s well known that certain medications can increase fall risk—and that post-acute care pharmacy providers play a key role in mitigating that risk. Pharmacy providers must work alongside other members of the SNF’s multidisciplinary team to help lower fall risk among all residents.
Every healthcare provider knows that medication can contribute to falls, especially in older adults. Seventy-two percent of people ages 55 and older use at least one medication, with 20.3 percent of that group using four or more.
The high rate of medication usage in this population has led to a rise in adverse drug reactions (ADRs), a particular concern for long-term care providers, who are tasked with keeping residents out of the hospital.
With a growing aging population who are being prescribed an increased number of medications, an interdisciplinary approach to fall management is vital.
Pharmacists are uniquely equipped to lend their medication expertise to the rest of the care team in order to improve resident outcomes. Let’s explore how pharmacists and post-acute care pharmacy professionals can contribute to an interdisciplinary approach to fall management.
Healthcare professionals often assume that residents have been educated on and, as a result, understand their medications. Many healthcare providers lack the time to adequately educate residents on their medications and disease states.
The post-acute care pharmacy team can help solve these medication-related issues—they’re considered the most accessible healthcare professionals and have an intimate knowledge of medications and the potential issues they pose to residents. This knowledge can be transferred to both other members of the care team and SNF residents.
Through medication reviews and therapy management, long-term care pharmacy providers are able to reduce the chances of an older adult falling due to medication. As the pharmaceutical industry innovates, both the medications and the standard of care for disease states have become more complicated.
Resident education about both disease state and medications has taken on increased importance. Residents and care team members need to understand the purpose of each medication, its potential adverse reactions, and which medications can increase the risk of falling.
Utilizing post-acute care pharmacy services as part of your interdisciplinary approach to fall management can help provide residents with more educated supervision and care. Team members know the fall risk factors for each resident and can take steps to reduce those risks.
An issue that is especially felt in the long-term care setting is the transition of care. Poorly executed transfers of older residents from hospitals to the long-term care setting, from long-term care setting to long-term care setting, or from the long-term care setting to home carry the risk of fragmentation of care, poor clinical outcomes, inappropriate use of emergency department services, and hospital readmission.
Utilization of post-acute care pharmacy services and medication management can help provide residents with a more complete transition and help to reduce some of the errors seen in resident transition, specifically in regards to medication.
A major issue, especially regarding medication-related falls, is polypharmacy, or the use of multiple medications. Polypharmacy is prevalent among older adults, including those in the long-term care setting.
The Centers for Medicare & Medicaid Services implemented a quality indicator measure that targets residents on nine or more medications. A study that utilized this information found that 39.7 percent of SNF residents had polypharmacy as defined by the quality indicator measure. Residents age 85 and older represented the group with the lowest rate of polypharmacy, with nearly 35 percent of this group taking nine or more medications.
Polypharmacy has many far-reaching negative consequences, contributing to healthcare costs for both the resident and the healthcare system. There is an associated increased risk of taking a potentially inappropriate medication, an increased risk of outpatient visits, and an increased rate of hospitalization.
Post-acute care pharmacy team members can and must work with the other SNF team members to educate them on these consequences and risks—and how to mitigate them.
Polypharmacy also contributes to an increased rate of adverse drug events. In SNF residents, the rate of adverse drug events is twice as high in residents taking nine or more medications compared with those taking less.
Medication non-adherence has been associated with complicated medication regimens and polypharmacy, and can lead to potential disease progression, treatment failure, hospitalization, and adverse drug events. Polypharmacy has also been found to contribute to falls. A study found that the risk of older adults experiencing a fall rose 7 percent for each additional medication they are prescribed.
At Grane Rx, we’re committed to providing SNF residents with the utmost care—and that includes an interdisciplinary approach to fall management, including post-acute care pharmacy services. Get started working with our team today by calling (866) 824-MEDS (6337) or filling out this quick form.
Deoxyribonucleic acid (DNA) determines the color of our hair eyes. It dictates how tall we will be and even how we will respond in certain situations. In essence, DNA completely makes up a human being. So how does this occur?
When conceived, an unborn child inherits 50 percent of the father’s DNA and 50 percent of thee mother’s DNA. Obviously there is no choice as to which parent’s DNA will affect what, but in the strictest sense, a child is one half of either parent.
DNA is a self-replicating material present in nearly all living organisms that is the carrier of genetic information. Not all DNA is accessible at a single point in time. Therefore, your body only accesses the specific areas that it needs. A specific region of DNA that codes for a specific product is called a gene.
For example, if your body needed to make more clotting factors due to a bad bleed, your body would access the gene responsible for providing the template for these proteins and would make them based upon the blueprint. Human beings have approximately 24,000 genes.
This is important to know in the field of medicine. Your unique DNA causes your body to metabolize certain medications differently. The specific area that focuses on this phenomenon is the field of pharmacogenomics.
Grane Rx offers pharmacogenomic testing through the Medication Insights program. But how can pharmacogenomics impact medication regimens for long-term care residents? Read on to explore the issue.
Pharmacogenomics (Pgx) is the study of how genes affect a person’s response to medications. Until recently, medical experts thought that medications were a “one-size-fits-all” solution. For example, if a certain amount of a drug taken daily prevented clotting around a stent in individuals in clinical trials, then it was thought to do the same in every other individual.
Pharmacogenomics has disproven this phenomenon. Depending upon an individual’s genes, he or she may benefit, not respond, or be negatively affected by certain types of pharmacotherapy.
So the question then becomes, how do we know how a person will respond?
Without testing to confirm an individual’s genetic makeup, doctors cannot be sure how he or she will respond to certain medications. Fortunately, genetic testing is now an efficient and cost-effective exercise.
Testing and analysis have become so streamlined that the generated report will advise a practitioner to consider an alternative, proceed with caution, alter a dose, or continue therapy unchanged.
This means that Pgx testing can truly personalize post-acute care pharmacy for every individual. With the results, providers can maximize benefits and minimize negative outcomes.
The already reasonable cost of pharmacogenomics testing can be offset by preventing an unnecessary hospitalization one time in a person’s life.
This is relevant for residents of Skilled Nursing Facilities as adverse effects of medications are more pronounced in the elderly population. Those that require assisted living are usually taking multiple medications for various disease states.
Therefore, using the information from Pgx can personalize their medicine and decrease the number of medications they take, the number of side effects they experience, and any doubt that they may have regarding the efficacy of a certain medication.
The Grane Rx team works with Skilled Nursing Facilities to design and implement medication safety and care transition processes. Could your SNF benefit? Call (866) 824-MEDS (6337) to find out more.
Antibiotics are one of the most widely prescribed classes of medications in the United States. They’re also one of the most overly and inappropriately prescribed medications, particularly among the senior population. Constant or inappropriate use of antibiotics can worsen a resident’s health, potentially affecting his or her gastrointestinal, renal, and/or hepatic functions. Furthermore, some antibiotics can cause neurologic and psychiatric disorders. For these reasons, it’s vitally important for post-acute care providers, including post-acute care pharmacy services, to stay informed about antibiotic best practices. Read on for a look at key factors that should be taken into consideration when selecting antibiotics for Skilled Nursing Facility residents. [Tweet “#Antibiotics are one of the most overly and inappropriately prescribed medications among seniors.”]
When choosing the most appropriate antibiotics for SNF residents, several factors must be taken into consideration. Here are four key factors that should be assessed before prescribing an antibiotic.
First things first: Determining what kind of infection the resident has. For example, is the infection pneumonia, or is it a urinary tract infection?
Once the infection type and severity have been determined, it’s important to look for the bacteria and pathogens that likely caused the infection. Often, a culture is taken to accurately identify the bacteria.
Some facilities and healthcare settings have an antibiogram, which shows known bacterial resistance rates to medications in the local area.
It’s not uncommon for SNF residents to have certain medical conditions, such as decreased kidney or liver function, or take chronic medications that can potentially be affected by specific antibiotics.
Cost can be an important factor, as some medications may offer decreased monitoring or be slightly more effective but are only available in an expensive, name-brand form.
Because residents are often on a limited income, it’s important for post-acute care pharmacy providers to discuss the various options available with residents and their families.
Once a diagnosis has been made and the likely pathogens have been determined, antibiotic therapy should be started.
The first wave of antibiotics is usually referred to as “empiric” therapy, which aims to start fighting the infection and reduce the risk of further complications. Empiric therapy usually consists of broad-spectrum antibiotics, such as ciprofloxacin (Cipro®) and doxycycline (Vibramycin®, Adoxa®), that can fight against many different strains of bacteria.
Once culture results are in and the causative bacteria is found, the resident should be switched to a narrow-spectrum antibiotic—such as gentamicin (Garamycin®) or vancomycin (Vancocin®)—that will target only specific types of bacteria. The chief benefit of this type of antibiotic is that it attacks bacteria more effectively, while also reducing the risk of increasing drug resistance in other bacteria.
If a culture comes back negative for any bacterial infection, however, empiric antibiotic therapy should be discontinued and the resident’s condition should be reassessed.
After an antibiotic has been selected, a care plan, detailing the length of therapy and date of termination, should be determined.
Finally, it is important to ensure the resident takes every prescribed dose of antibiotic until finished to ensure proper bacterial eradication and reduce bacterial drug resistance.
Regardless of which antibiotic is ultimately chosen, it is important to follow proper procedures and only use these medications when clinically appropriate. By selecting the best antibiotic and duration of therapy for each resident’s needs, we can effectively treat infections while also reducing the risks associated with overprescribing or inappropriately prescribing these medications.
The Grane Rx team stays up-to-date on the latest information related to long-term care pharmacy—and passes that knowledge along to your team. Call (866) 824-MEDS (6337) or fill out this quick form to find out how your SNF could benefit.]]>
At Grane Rx, we’re committed to providing the highest-quality LTC pharmacy services. As part of that commitment, we share an ongoing series of pharmacy updates from our Chief Clinical Officer, designed to keep you in the know on clinical topics related to long term care pharmacy and PACE pharmacy.
As we know, all psychotropic medications are associated with adverse effects, especially in the geriatric population. Although antipsychotics have historically been associated with the most significant adverse effects, including an increased risk for falls, recent data suggests that antidepressants may be a more significant contributing factor to falls in the geriatric population.
Antidepressant medications have a profound effect on the body’s neurotransmitters (serotonin, norepinephrine, dopamine, etc.) that can cause alterations in sleeping patterns, postural reflexes, reaction times, orthostatic hypotension, cardiac rhythm, movement disorders and others. While the antidepressant may not be the direct cause of falling, it may be the underlying cause. For example, antidepressants can affect a resident’s sleeping pattern causing an increase in daytime drowsiness thus increasing the probability of a fall.
While evaluating the risk for falls and establishing fall precautions for residents, it’s important to take into consideration all psychotropic medications, including antidepressants. If there are residents who are predisposed to falls, careful attention should be given if antidepressant therapy is initiated or when doses are altered. Overall, all medications have benefits and risks that need to be evaluated on a resident-by-resident basis. While this new data is not likely to change prescribing habits or the management of depression, this information can help you better manage the adverse effects potentially associated with antidepressants.
The admission process for Skilled Nursing Facilities is multifaceted and can be challenging. Timeframes for reviewing and accepting new admissions are becoming tighter, making timely pre-admission medication cost estimates vitally important. Pre-admission cost estimates help admissions coordinators gain a complete understanding of the costs of the medication regimen for a prospective resident. Through a comprehensive cost estimate, providers can ascertain areas where a medication regimen could be optimized to remain clinically effective while benefiting from cost reduction. While medication pricing is available through many long term care pharmacies, very few offer the level of sophistication that Grane Rx offers. The Grane Rx MedExpense Evaluation Tool benefits admissions coordinators in three key ways:
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.
When you’re switching to a new pharmacy services provider, you want the transition to be seamless, so that staff and residents alike experience little or no negative impact. In choosing a new pharmacy services provider, it’s important to consider multiple factors, including the depth and thoroughness of a provider’s transition plan.
Grane Rx understands the importance of getting started on the right foot. When we partner with a new Skilled Nursing Facility or PACE program, we rely on a tried-and-true formula with several key components to pave the way toward a seamless transition.
The first step in the Grane Rx transition process is, quite simply, to thoroughly explain the process. In a kick-off meeting, our team meets with the center’s team to review the transition plan in detail and clarify any areas of concern or questions.
During this meeting, our teams also work together to establish a communication plan and schedule for the transition itself.
The second phase of the process includes a look at the current status of pharmacy services at the SNF or PACE program. During this stage, the Grane Rx team develops a gap analysis, comparing actual performance with desired performance.
This analysis helps us formulate a framework for pharmacy services moving forward, one that makes the best use of capabilities and cultivates optimal performance.
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Pharmacy orders play an integral role in the everyday functionality of pharmacy services, and our goal is to make placing them simple for your team. In order to do this, our electronic health record adapts to integrate with the EHR already in place in your center. This allows data to transfer in real time from your center to our pharmacy.
During this phase, our IT team tests the functionality of EHR data integration to ensure the kinks are worked out before services go live and then configures the pharmacy information system.
Following this step, we begin to work with the center’s personnel to review processes and formulate implementation plans, which will include comprehensive, interdisciplinary training. As we begin the final stages of preparation, our team will also review final processes.
When pharmacy services go live, the Grane Rx pharmacy team will be onsite to ensure a smooth transition. This continues past the initial days—during the first 90 days after going live, key members of the Grane Rx team remain onsite to work with staff.
In addition to working with staff members to ensure things start on the right foot, our team also meets one-on-one with residents or PACE participants. These meetings give residents the opportunity to gain familiarity and comfort with the expertise of our team.
Interested in learning more about the pharmacy services Grane Rx can provide for your Skilled Nursing Facility or PACE program? Call (866) 244-MEDS (6337) or reach out to us here.]]>
In the modern world, technology is everywhere, impacting everything from what we eat to how we communicate. In the long term care setting, technology plays a significant role in helping provide residents with safe, quality care.
Given the large number of prescription medications elderly residents typically take, the role of pharmacy technology is especially important in medication management. Read on for a look at three key ways pharmacy technology positively impacts long term care.
When dispensing large quantities of medications to multiple residents, there is potential for disorganization. The use of automated medication dispensing cabinets largely mitigates that potential.
With automated medication dispensing cabinets, medications are stored, dispensed and tracked at the point of care. This access allows for the timely administration of medications and increases the time nurses can devote to resident care.
Grane Rx takes that technology a step further with SimpleAccess Cabinets. These cabinets provide a number of benefits within the long term care setting, including additional safety measures, automated and streamlined documentation, and improved nursing access to medications. The most unique aspect of SimpleAccess cabinets is the Anywhere RN Solution, a web-based application that allows nurses to complete tasks related to medication management while away from the cabinet.
The SimpleAccess cabinets also provide enhanced safety measures. Real-time resident profiling, organized dispensing bins and automated temperature controls are all implemented as part of the SimpleAccess technology.
The way medications are dispensed is another key safety measure. Grane Rx utilizes SimplePacks, resident-specific, multi-dose packaging that helps to largely reduce medication errors. This packaging technology uses automation to package medications according to when they will be taken—morning, noon, evening, at bedtime and on an as-needed basis.
While the SimplePacks themselves help reduce the risk of preventable medication errors by simplifying the process of taking medication for residents, Grane Rx provides another level of safety with InspectRx technology. This automated imaging technology checks to ensure that each pill in every SimplePack matches the resident it is being dispensed to. The technology checks for 12 pill indices, including color, shape, size and manufacturer.
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Effective communication between all providers in a long term care setting is imperative. In order to enhance communication between Grane Rx pharmacy providers and other providers within your Skilled Nursing Facility or PACE center, we utilize SimpleView technology.
SimpleView is a secure communication portal designed to specifically meet the needs of each center. The tool, which is an online portal, offers providers 24/7 access to analytical tools, resident data and reports.
In one key aspect of the portal, admission coordinators can search for medication cost estimates specifically tied to the individual center’s contract pricing and pharmacy inventory.
Pharmacy technology’s role in long term care cannot be understated. Grane Rx is ahead of the curve, introducing technologies that positively impact several facets of provider access and resident safety. Grane Rx also interacts with your technology, integrating with your center’s electronic health record system. ]]>
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.
Seniors typically deal with a multitude of comorbid medical conditions, requiring a significant number of medications. In fact, according to the American Society of Consultant Pharmacists (ASCP), while the elderly population makes up less than 15 percent of the total United States population, they consume 40 percent of all prescription medications. The goal of PACE pharmacy, then, is to ensure the highest level of safety in medication management. To facilitate that goal, Grane Rx’s Precision Medication Management program utilizes a three-part approach designed to provide cost-effective solutions to the pharmaceutical needs of participants of your PACE center.