Doris Yee

Senior care, especially in long-term care facilities, is becoming more and more complex. The dynamics of patient care are changing in this setting as the health care team works to reduce avoidable hospitalizations.  At the same time, the acuity of care in the LTC setting is increasing with the push to treat certain acute changes in condition here rather than transfer the resident to a hospital.

These new clinical interventions in LTC may entail new drug therapies not previously employed in these facilities, and more monitoring may be necessary by clinical staff of those medications.

There is room to improve the quality of care and medication management in LTC.  There are opportunities and challenges for preventing adverse drug events of which we should be mindful.  

In this article, I’ll discuss the most vulnerable ADE areas for providers, how senior care providers can address these vulnerabilities in ways that best sets them up for success, how an EHR and other workflow tools can help to improve prescribing and monitoring of drugs to reduce ADEs, and common mistakes providers are making in avoiding ADEs.

Optimize proper medication reconciliation

As soon as possible after a resident’s admission, have your consultant pharmacist perform a comprehensive medication reconciliation. The pharmacist can help identify and correct missing medication orders and incorrect dosages, as well as identify and prevent ADEs due to unnecessary medications, duplicate therapy, polypharmacy, and other inconsistencies in the medication regimen. Transitions of care are a high risk time for medication errors and your consultant pharmacist can help mitigate this risk.

What are possible barriers to carrying out this strategy? There may be consultant pharmacist staffing limitations and lack of reimbursement for expanded clinical services.

One long-term solution is to advocate for and achieve national provider status for pharmacists, so they can be recognized and compensated for their clinical expertise in minimizing ADEs and optimizing medication management in all care settings.

Another barrier is not having access to resident information, such as the current inpatient medical record and history, diagnoses, and lab results. In an integrated health system, the best case scenario would include access to the electronic health record system between the inpatient hospital and LTC facility. Realistically however, for the majority of hospital transfers to community LTC facilities, this is not the case. Knocking down this barrier would improve the ability to review the medication profile within the full clinical context and maximize the quality of the medication reconciliation process. In general, having access to a patient’s medical history during any transition of care can help to bridge gaps in communication or knowledge.

In my next blog, I’ll discuss strategies for addressing two of the most vulnerable areas for adverse drug events:  inappropriate prescribing/dosing and inadequate monitoring of medications.

Doris Yee, PharmD, currently serves as a clinical pharmacist in the Consumer Drug Information Group at FDB (First Databank, Inc.) where she is responsible for maintaining the patient education monographs, prioritized label warnings, and counseling messages modules. Her past experience in long-term care includes serving as Director of Pharmacy at Laguna Honda Hospital and Rehabilitation Center in San Francisco, CA.