medication management in assisted living lessons from current research
TRANSCRIPT
Medication Management in Assisted Living
Lessons from Current Research
85%of assisted living residents require assistance with medications
NCAL
NSRCFFirst time national assisted living data collection effort by the CDC/NCHS/ASPEwww.cdc.gov
NCALAssisted Living State Regulatory Review 2012 – www.ncal.org
CEALNonprofit collaborative of 11 national organizations:Alzheimer’s Association, AALNA, AAHSA, AARP, ASHA, ALFA, CCAL, NCAL, NCB Capital Impact, PVA, Pioneer Network
BackgroundResearch
Challenges
Recommendations
Older adults take an average of5 prescription medications per month
CEAL
Those with 3+ chronic health conditionsAverage 6-7 prescription medications per month
CEAL
Assisted Living Residents 10 routine medications per
day
3 PRN medications per day
state regulations
are all over the
map
10 statesutilize nurse delegation
20 statesallow unlicensed assistive personnel to administer medications
20 statesrequire “assistance with self-administration”
“assisting with self-administration”a regulatory play on words
Background
ResearchChallenges
Recommendations
Observational Study:Oregon Health and Sciences Institute, Rutgers, University of Washington, and Northern Illinois University
28.2%medication error rate in assisted living
70.8%of medication errors in AL are related to dose timing
8.2%error rate when “time” errors are removed
No errors were judged highly likely to cause harm (out of 1373 errors)
CEAL/UNC Research:
35%of medication administrations involved an error
71%of errors were again related to dose timing
< 3%of errors had moderate to significant potential for harm
Med Techsdid NOT have a higher error rate than nurses
Written testresults “predicted” likelihood of errors
Background
Research
Challenges
Recommendations
Challenges:
Large volume of routine medications
Challenges:
PRN Medications
Challenges:
Injections
Challenges:
Healthcare providers who do not specialize in geriatrics
Background
Research
Challenges
Recommendations
Focus on high-riskmedications
1/3 of emergency room visits by older adults presenting with ADE are caused by 3 drugs:
•Warfarin•Insulin•Digoxin
CEAL/UNC Research Showed majority of errors with potential for harm related to:
•Warfarin•Insulin•Risperidone
Warfarin• Monitor for s/s of bleeding• Coordinate lab tests• Monitor OTC use
Insulin• Follow delegation procedures• Monitor residents who self- administer
System Redesign
Consistency in medication management regulations across states
System Redesign
Improve training of unlicensed assistive personnel
System Redesign
Streamline documentation, perhaps through use of electronic health records
Individualized Medication Plans Promote person-centered care in all aspects of resident care
Individualized Medication Plans Tailor medication schedule and use of PRN medications
Individualized Medication Plans Based on resident decision-making capacity, needs, and lifestyle choices
