High-Risk Medication ECHO® Series Resources
According to the World Health Organization (WHO), unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems. The Age-Friendly Health System (AFHS) aims to follow an essential set of evidenced-based practices, cause no harm, and align with the 4Ms. Placing a monitoring system of medication management to make necessity decisions and ensuring medication does not interfere with what matters, mentation and mobility. Nursing home teams, prescribers, pharmacists, admission and discharge planners, and many others across the care continuum share a common goal to improve patient outcomes.
This resource contains the recordings and supplemental materials for the Wake Up Wednesday: High-Risk Medication ECHO® Series. The objective of this series is to improve patient outcomes by learning from subject experts that will share key information and strategies focusing on high-risk medication management, resident safety and quality of care.
Learn more about the Age-Friendly Health System by clicking here.
Review each session’s brief summary on this website to prioritize and select which to bring to facility leadership and Quality Assessment and Performance Improvement (QAPI) meetings. Take action:
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- Watch the session recording
- Use tools and resources
- Implement the call to action under each session title
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Click to expand each session and view session details.
Session One: Regs and Meds and Errors – Oh My!
Description: Vicki Worth, Medicare/Medicaid LTC Bureau Chief I with the Iowa Department of Inspections & Appeals navigates the regulations, risks leading to errors and safety concerns. This session will describe the relationship between high-risk medication management and the potential impact to nursing homes; discover resources to support medication management processes and recognize opportunities for collaboration which may impact positive outcomes.
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Resource: Access the presentation to view the regulation map and assist with your navigation of the many regulations tied to the medication management system. Links to each regulation code and page numbers to the State Operations Manual – Appendix PP are provided. Review one regulation code at a time to familiarize yourself with the expected practice and processes. Incorporate this information into your daily routine.
Call to action:
- Explore the regulation to be informed of the required elements and impact in LTC
- Share your vision on improving the medication management system with all those involved in the medication management system
- Bring your high-risk medication management program to Quality Assessment and Assurance (QAA) meetings
- Set a goal – Identify data measures – Test change ideas
Session Two: Adverse Drug Events
Description: Denton Chancey, PharmD, MBA, Clinical Pharmacy Specialist provides a broad overview of adverse drug event classification, impact and epidemiology, discusses interventions to decrease incidence of adverse drug events and describes the impact of adverse drug events on patients and society.
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Resource: Adverse Drug Event triggers tools such as the CMS Adverse Drug Event Trigger Tool may assist you in identifying risk factors for adverse drug events, develop systems and processes as well as appropriately responding to mitigate harm to the individual and prevent recurrences.
Call to action: The IHI Skilled Nursing Facility Trigger Tool for Measuring Adverse Events (slide 14) challenges us to investigate triggers, determine if an adverse drug event has occurred, develop a systematic analysis and corrective action plan, measure the effectiveness of change and study the result for further action or sustainment achieved.
Session Three: Behavioral Support for Residents in a Long-Term Care Setting
Description: Dr. Cari Levy, Geriatric Specialist, explores evidence-based strategies and experiences from peers to provide behavioral support within our communities. During this session we will share resident perspectives for some common causes for behaviors and offer whole-person approaches using non- pharm interventions to support residents exhibiting behavioral challenges.
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Resource: The Describe, Investigate, Create, Evaluate (DICE) approach online training program is intended to provide caregivers the education, expertise, confidence and strategies needed to better assess and manage the behavioral symptoms that so frequently accompany dementia.
Call to action: Meet as a multidisciplinary team and try the Describe, Investigate, Create, Evaluate (DICE) approach (slide 14) to address behaviors and potential unmet needs.
Session Four: Beyond Meds: Meeting the Needs of Elders
Description: A person-centered approach to reducing the off-label use of antipsychotic medications for persons living with dementia is highly recommended. Denise Hyde, PharmD, a Community Builder from The Eden Alternative® discusses the impact of medications on elders, reframing “problem behaviors” as unmet needs and share successful person-centered strategies to understand and alleviate a person’s distress without relying on medication.
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Resources:
- Our Framework – The Eden Alternative® The Eden Alternative Domains of Well-Being®️ are 7 fundamental aspects of personhood that are the core of our Framework. They are the outcomes care partners achieve when they put the Ten Principles of The Eden Alternative®️ into action
- CMDA – Colorado Dementia Partnership All About Me! A Tool for Transitions (slide 11) is used for persons living with dementia to tell staff information about their history so they can provide person-centered, supportive
Call to action:
- Review and discuss the Domains of Well-Being with the interdisciplinary team (slide 10)
- Evaluate care plans – Are they individualized focusing on strengths, preferences, goals and growth?
- Discuss opportunities to ensure well-being is addressed in the care plan process
Session Five: Gradual Dose Reduction (GDR) for High-Risk Medications
Description: Gradual dose reduction (GDR) is especially important in vulnerable populations who are at risk for adverse side effects associated with high-risk medications. Dr. Leslie Eber, Geriatric Medicine Specialist, will express the advantage of a collaborative approach across the care continuum with the purpose and process of GDRs for high-risk medications to improve quality of life.
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Resources:
- The Psychopharmacology (“PsychPharm”) Meeting is an opportunity for the Interdisciplinary Team (IDT) to review psychotropic medication usage. Use this PsychPharm Tracking Tool from the Dementia Partnership to drive discussions about medications and approaches
- This two page flyer is a quick reference to identify when to use psychotropic mediations when person-centered and non-medications have been unsuccessful
Call to Action:
- Ensure your psych-pharm meeting is interdisciplinary building on collaboration across care settings
- Bring your high-risk medication management program to Quality Assessment and Assurance (QAA) meetings
- Start quality improvement efforts to reduce high-risk medications
Session Six: Communication Across the Care Continuum
Description: Implementing communication practices and processes among providers can be a challenge, but a challenge we can embrace in meeting patient needs and providing safe, high-quality and patient-centered care. Dr. Gregory Gahm, Chief Medical Officer of Vivage-Beecan Colorado, discusses communication best practices that promote positive patient outcomes and enhance care coordination for medication prescribing. Embrace opportunities to build communication using Leadership and Organizing in Action (LOA) framework.
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Resources:
- Practice communication skills across the care continuum using the evidenced-based tool SBAR Communication Form from INTERACT (slide 22)
- Access the presentation to learn the five steps in the LEAD!LOA one-on-one framework (slide 22). This strategy can be implemented when conversing with providers, family, and even staff within your own facility to have meaningful conversations about medication management
Call to Action: Meet as a leadership team to identify high-risk medication management gaps, create a goal for improvement and deploy the quality improvement team. Use the evidenced based Quality Assurance and Performance Improvement (QAPI) framework to guide the team in root cause analysis, developing a plan for improvement and running Plan-Do-Study-Act cycles to ensure sustainability.
Session Seven: Communicating with Residents and Families
Description: Communication with residents and family about high-risk medications can be challenging. This session will use the lessons learned in this ECHO® series to offer solutions for achieving effective communication between those explaining and those giving consent for high-risk medications. Informed consent is an important step to closing the gap in communication practices.
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Resources:
Build communication with residents and their representatives by using AHRQ’s Making Informed Consent an Informed Choice implementation guide (slides 10-12) coupled with this Teach-Back: Intervention (slides 13-14) to ensure that you have explained medical information clearly so that residents and their families understand what is communicated to them to make informed decisions.
- Use this Nursing Home Resource Guide for Adverse Drug Events (slide 20) to assist in recognizing and reducing adverse drug events
Call to action: Use all seven sessions collectively to build up a well-functioning high-risk medication management program. No matter which role (internally or externally) you play in the medication management process for long-term care, you can impact the quality of safety and care of the many Medicare beneficiaries across the nation.
Download the Nursing Home Resource Guide for Adverse Drug Events
Outer ring: Four domains and descriptors affecting the high-risk medication management system
- Do they function well or are you discovering challenges?
Light gray ring: Areas for continuous monitoring ensuring domains function to their fullest potential
- Are you addressing these areas and implementing action when you find challenges?
Age-Friendly Health System Series
As presented on Give Your Nursing Home a Boost!
Overview of the 4Ms and What Matters Most | Part 1 of 3
September 19, 2023
Medications and Mobility | Part 2 of 3
September 26, 2023
Mentation: Dementia, Delirium and Depression | Part 3 of 3
October 3, 2023
Learn more and access resources specific to managing anticoagulant/blood thinner medications by visiting Telligen’s Anticoagulant ECHO® Series resource page.
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