Author: Dr Chris Alderman, Clinical Director, Ward Medication Management
Anyone working in aged care will know that as people grow older, many are affected by multiple medical illnesses and general frailty. Eventually these issues take a toll and are reflected in frequent periods of disability, hospital stays, pain, confusion and other suffering. The economic impact is enormous, measured in many ways but including the staffing required for complex care, increased medical care, and extensive use of medications. The standards in contemporary Australian aged care are probably among the very best in the world, but what could we do better?
Medications can have a downside for older people
In Australia we enjoy first class aged care services. However, looking after the health of older people is incredibly complex. Although there are many different elements involved in medical care for older people, safe and effective medication use cannot be underestimated. Older people take more medicines, experience more side effects and drug interactions, and have a much higher rate of medication-related hospital admission and death. The balancing act can be a difficult one.
Medications used to treat one illness can have a serious adverse effect upon another condition. For example, a course of cortisone-style medication used for a lung condition such as asthma can destabilize the control of blood sugar levels for a diabetic person. Some medications don’t mix well – even a simple course of antibiotics can completely change the effects of powerful anticoagulant medicines (“blood-thinners”) that are very commonly prescribed for older people.
Quality use of medicines – what is it?
Fortunately there is something that can be done. The Commonwealth Government of Australia has created policies and programmes that are designed to support a concept called Quality Use of Medicines (QUM). QUM can be summed up in simple terms as the things that can be done to ensure that medication options are selected wisely, using these safely and effectively (appropriate monitoring of outcomes, minimising misuse, and improving access information about medication). QUM requires partnerships and consultation involving consumers and their families, as well as doctors, nurses, care staff and pharmacists.
Importantly, Department of Health have acted to sustain QUM in aged care by directly funding key activities, including funding to support education and training, monitoring of medication use, and the process of Residential Medication Management Reviews (RMMRs) that are conducted by specially trained and accredited pharmacists.
QUM in aged care facilities is an important way to reduce the impact of medication related harm for the elderly. Ward Medication Management (Ward MM) is a leading provider of QUM services in the aged care industry, working with aged care providers and medical staff to implement strategies to optimise medications for residents and also at the facility level. Staff deliver these results by putting the resident at the centre of everything we do, focusing on optimising medication use by delivering key strategies such as RMMR, QUM training and sophisticated monitoring of medication usage patterns in the aged care setting through the use of advanced information technology (IT) infrastructure.
Medication reviews – enhancing care and saving lives
RMMRs are a critical element that support the health and wellbeing of older people in residential care. The process starts with a referral from the GP to allow the RMMR to be initiated. Any resident can have an RMMR, either on a routine basis as a check-up, or as often as the GP feels is needed on the basis of clinical need.
The accredited pharmacist uses a structured approach to analyse the resident’s medication therapy along with the medical history and the results of investigations such as blood tests, X-rays. The pharmacist develops a detailed report that gives feedback and recommendations about the situation, provided to both the GP and to the facility.
A typical report contains recommendations about suggested dose modifications, recommendations for introduction or discontinuation of drugs, and suggestions related to monitoring. The RMMR report is an important tool for the GP and facility to use in caring for the individual resident, but the process does not stop there.
Sophisticated information technology to improve medication use and deliver cost savings
By using a sophisticated IT platform to deliver RMMR services, technology allows the development of powerful insights into medication use at the level of the local facility, and on a wider scale. Each time a review is completed, the anonymised data is added to a data set that can be analysed to support QUM.
The aggregated data from reviews is used to support facilities in accreditation requirements. Guided by data, the pharmacists deliver education about medicines in a variety of formats tailored to the specific needs of facilities. By analysing actual medication usage patterns in each facility, the training can be adapted to ensure that the information provided is relevant. The same data can be used to guide discussions at Medication Advisory Committee (MAC) meetings, allowing the effective use of time to focus upon issues of genuine concern in the local context. This helps in building GP engagement and also in the timely identification of risks that require a rapid response.
The analysis of data can also assist in the identification of situations where a ‘helicopter” view of medication usage can provide unique insights about the way medications are used in a specific facility, when compared to other facilities of a similar size or resident mix, or to provide an understanding of medication use across a group of facilities from a specific provider. The information can be used to assist in delivering cost savings through reduced wastage and inappropriate medicine use. In some cases, data might be utilised to enhance occupational health and safety for facility staff.
By using these services, facilities can reduce medicolegal risk and mitigate risk of brand damage that can arise from medication errors. At Ward MM, the insight we gain through applying this data analysis to our medication management services is both invaluable to the facilities we work with and most importantly the residents themselves.
- Chris Alderman is Director of Clinical Excellence at Ward Medication Management: wardmm.com.au
Dr Chris Alderman will be speaking on “Using organic clinical data to enhance productivity, reduce costs and protect the safety of every resident in aged care” at the 2nd Annual PASA Aged Care Procurement Conference on 24th and 25th May 2016 at Melbourne Olympic Park, Details here