QA/PI and residents with 9 or more medications

[geriatricRNBSN, BSN, RN]

We've just started our QA/PI. Others at the meeting were choosing the usual falls, staff retention, anti-psychotics etc. We've decided to take a different approach - residents with 9 or medications.

Is anyone else using this as your QA/PI and if so, how are you approaching this? If you have already implemented this, how is it going?

My AIM is to decrease the number of unnecessary medications to improve: Falls, Med Pass times, decrease our pharmacy expenses, decrease the pill burden for our residents and decrease adverse drug reactions.

We are starting with the Pharmacy Review of Residents on 9 or more meds, starting with those closest to 9 meds vs those who are on like 26 meds.

Just interested if anyone else is tackling this problem. I became interested in it when I saw my nurses doing nothing but passing meds. What measures are you tracking. I want to be thorough but not overwhelmed!

[NutmeggeRN, BSN]

I think that is a great idea! The number of meds that some folks are on is crazy! MY DON does look to decrease when the doc is in but sometimes the DMPOA are reluctant to make a change

[geriatricRNBSN, BSN, RN]

What is a DMPOA - family? :-)

[NutmeggeRN, BSN]

What is a DMPOA - family? :-)

Whoever is the durable medical power of attorney, usually family soemtimes a friend.

[CapeCodMermaid, RN]

We'd be celebrating if our residents had 9 meds....the average is around 22 with a high of 29 scheduled meds....horrible.

[geriatricRNBSN, BSN, RN]

I see what you mean with the DMPOA. I've found it depends on who the payor source is. If they are private pay, they are more likely to want to reduce the pharmacy bill vs. Medicaid residents' families who pay nothing out of pocket. So far, I've had good luck with those closest to 9 meds. I try to pick 2 residents a week. I will continue this.... Perhaps I should monitor the payor sources as an additional step just to see how that pans out regarding how many meds a resident gets.

[catband]

I would love if all of my residents had 9 pills. hell I would love it if one of my ladies didn't have 42 to take at 8 AM(I'm sure she would too) most of mine average between 12 and 32 on a good day.

[motherof3sons]

Recently at our facility they weeded thru some of the meds and d/c'd a bunch....like cal/vit d if the resident was non ambulatory, monitoring b/p and d/c'ins some of b/p meds with daily monitoring of b/p, checking labs and d/cing omega 3 if appropriate ect.....all of our MD's were on board with this. Took lots of time, documentation and such but worth it in the long run.

[TeresaBuchman]

My organization has begun to really monitor the psychotropic medications. This the big focus with CMS. We have begun using a fact sheet with all the black box warnings for these medications as a teaching tool for the families and residents. We are getting signatures that they acknowledge that they received the information. They are then told (also written in the fact sheet) that they should discuss with the MD an questions about their use. We have really begun to reduce some of those medications.

[Here.I.Stand, BSN, RN]

re: DMPOA, perhaps some education about the risks of polypharmacy in the elderly is in order? Esp. with high fall risk meds. That way it becomes about what is in their loved one's best interest (which it is), vs. a financial decision.