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.
Post-Acute Care Pharmacy Can Help Educate Residents About Medications
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.
Post-Acute Care Pharmacy Can Help Monitor Polypharmacy
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 and Post-Acute Care Pharmacy
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?
Medication Response in Post-Acute Care Pharmacy
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.”]
Post-acute Care Pharmacy Update: Understanding the Basics of Antibiotic Selection Criteria
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.
1. The type and severity of the infection
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.
2. The existence of known drug resistance in the local community
Some facilities and healthcare settings have an antibiogram, which shows known bacterial resistance rates to medications in the local area.
3. The presence of any limiting factors or contraindications
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.
4. The cost of available options
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.
Post-acute Care Pharmacy Update: Therapies for SNF Residents Battling Infections
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.
Antibiotic Usage in SNF Residents: Final Considerations
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.
What Long term Care Pharmacy Providers Can Do about Fall Risks associated with Antidepressants
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.
List of Common 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 MedExpense Evaluation Tool Is Easy Grane Rx utilizes a simple user interface to allow non-clinical admissions coordinators to quickly and easily search for medications and the associated costs. The system is customized for each Skilled Nursing Facility, integrating the center’s therapeutic interchanges and preferred medication programs built into the MedExpense Evaluation tool. Because of this level of customization, when users input a medication, they are guided to the center’s preferred clinical and cost-effective treatment options. Customization doesn’t end there. As time goes by and the MedExpense Evaluation tool is utilized within a SNF, the system acclimates to the most commonly used medication products. As a result, searches become smarter and easier for admissions coordinators. [Tweet “What to know about pre-admission medication cost estimates in #LTCpharmacy”]
The MedExpense Evaluation Tool Is User-friendly When working with any type of technology, you want the technology to be intuitive to operate. The MedExpense Evaluation tool fits the bill, providing admissions coordinators with a user-friendly experience. When an admissions coordinator selects a medication within the system, the tool will provide a list of common order instructions for that particular medication. This helps minimize the amount of typing and manual calculation necessary for an accurate cost estimation. In addition, for complex medications, such as compounded medications, the system steps users through the necessary information. Text within the system explains the information or calculation that is needed, which helps increase the number of successful quotes provided while minimizing the number of times the pharmacy needs to be contacted.
The MedExpense EvaluationTool Is Thorough The MedExpense tool also provides admissions coordinators with thorough information. Using the depth of information provided, the team at each center is able to determine a clinically optimal and cost-effective medication regimen for each resident. Within the system, users are notified if there are generic alternatives available for medications they’ve selected, so final cost estimates accurately reflect the medications that will be dispensed by the long term care pharmacy. Cost estimates themselves are provided based on a daily, weekly, monthly and annual basis. Admissions coordinators are notified within the system if they’ve selected a medication that is packaged and dispensed only in a certain size or quantity. Grane Rx is committed to providing optimal care and cost savings. Find out how we can help your Skilled Nursing Facility by filling out this quick form or calling (866) 244-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.]]>
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.
Part 1: Kick-off Pharmacy Services Meeting
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.
Part 2: Analysis of Pharmacy Services
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.
[Tweet “A strong transition plan for #pharmacyservices can help you get started on the right foot”]
Part 3: Training With Pharmacy Services Team
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.
Part 4: Pharmacy Services Provider Meetings With Residents
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.
Pharmacy Technology Improves Access to Medications
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.
Pharmacy Technology Adds a Layer of Safety
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.
[Tweet “Technology is everywhere. Learn about how #pharmacytechnology impacts #longtermcare.”]
Pharmacy Technology Enhances Communication
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.
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.]]>
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.
Precision Medication Management, Facet 1: Clinical Consulting Polypharmacy, or the regular use of more than four medications, is significant among the long term care population. The ASCP reports that people between the ages of 65 and 69 take an average of 14 prescriptions per year, while those age 70 or older take an average of 18. With an increased number of medications comes an increased number of side effects and the possibility of medication interactions. Grane Rx partners with PACE centers and the long term care industry to provide clinical consulting services. The foundation of these services are in-depth medication consultations to optimize participant medication therapy and outcomes. As part of clinical consultation, pharmacists implement a number of interventions, including:
The aim of all clinical consults is to help ensure positive outcomes for residents while helping PACE centers lower costs and make efficient decisions with downstream impact.
- Comprehensive medication regimen reviews
- Clinical change of status or emergency room/hospital admission reviews
- Targeted medication class and disease state management reviews
- Medication utilization optimization reviews to focus on reducing and eliminating polypharmacy
Precision Medication Management, Facet 2: Pharmacogenetics Pharmacogenetics is defined as variations in response to medications based on a person’s genetic makeup. In other words, different residents metabolize medications differently. Patient A may be impacted more profoundly by a medication or may have a more limited response or negative reaction than Patient B. Grane Rx has built a partnership with some of the industry’s leading pharmacogenetic testing companies in the country that provide state-of-the-art genetic testing and clinical decision support software. Utilizing innovative technology, providers can comprehensively analyze an individual’s genetic makeup and how his or her body absorbs medication. This risk assessment tool helps providers determine the most appropriate dose of medication for each participant—whether that’s a higher or lower dose than standard, the normal dose, or an alternative medication. In addition, it has the potential to reduce the use of unnecessary medications that were prescribed based on an adverse reaction to another medication. Pharmacogenetics will likely become a standard of care across health care, particularly in the medication management of the senior population. More precise medication orders have the potential to positively impact the provision of care and its associated costs, reducing medication side effects and improving resident outcomes. [Tweet “#Polypharmacy is a significant issue in #longtermcare. Innovative #medicationmanagement can help”]
Precision Medication Management, Facet 3: Preferred Medication Program Anyone involved in long term care will tell you that it’s imperative to optimize resident outcomes while containing costs whenever clinically appropriate. The Grane Rx Preferred Medication program helps PACE centers strike that careful balance when it comes to medication management. With each center it partners with, Grane Rx implements a customized, clinically appropriate preferred medication program to minimize medication costs. Through this program, Grane Rx works collaboratively with the facility to meet the therapeutic treatment needs of the residents and prescribers while optimizing cost containment efforts. The facility-specific preferred medication program is continually reviewed in order to incorporate the most cost-effective and clinically relevant medications. An automatic therapeutic interchange program is also included as part of the program. Want to learn about the impact Grane Rx services can have on your PACE center? Reach out to us here or call (866) 244-MEDS (6337).]]>