Skilled Nursing Facility pharmacy solutions. As science discovers more about how the human body functions and metabolizes medications, the potential to personally optimize medications for residents increases.

The topic of pharmacogenetics is increasing in popularity as we progress toward personalized medicine. We have learned a significant amount about how an individual’s genetic makeup impacts how medications are metabolized, which affects the efficacy and safety of a medication.

The missing link in most situations is understanding each resident’s genetic makeup so that can be related to the therapies he or she receives or may receive in the future.

That’s where post-acute care pharmacy must continue to grow and develop.

The Potential of Pharmacogenetics

Pharmacogenetics holds the potential of providing medical practitioners with specific genetic data that will allow us to tailor medications to individual residents. Providers could predict dangerous adverse reactions or identify therapies that would not be effective for individual residents if they could know a resident’s genetic makeup.

Routine pharmacogenetics is not normal practice at this time, but there are specific situations when it may benefit in current situations, including with anticoagulation and antiplatelet therapy.

Adverse drug events and medication nonadherence are a leading cause of hospitalization among residents. The majority of emergency hospitalizations caused by medication issues are linked to five specific types of medications: warfarin, insulin, oral antiplatelets, diabetic medications, and opioid pain medications.

In our efforts to reduce unnecessary hospitalizations, we must be willing to investigate newer, challenging avenues to find the root cause of medication-related issues.

Pharmacogenetics and Anticoagulant Therapy

Clopidogrel, otherwise known as the brand Plavix®, is a popular antiplatelet medication in long-term care pharmacy. Pharmacogenetics is a pertinent topic related to clopidogrel because clopidogrel is a prodrug, a type of medication that must be metabolized through the cytochrome P450 system before it becomes an active medication.

If a resident’s cytochrome P450 enzyme system is not functioning at its expected level, this will result in metabolism variations when processing clopidogrel, which ultimately means the medication may not be metabolized to the necessary active form.
Basically, we could be administering the medication to a resident exactly as ordered, but the body may not be reacting to it the way we expect. Pharmacogenetics would allow us to know if a resident’s cytochrome P450 system is functioning as expected prior to prescribing the medication.
Warfarin, popularly known as Coumadin®, is another key example.

Warfarin has a number of potential interactions with both foods and other medications. In addition, warfarin can also be very difficult to stabilize in some residents. The difficulty in stabilization could be caused by two different situations.

First, warfarin is metabolized significantly by the cytochrome P450 system, so variations in a resident’s cytochrome P450 system detected through pharmacogenetics could affect the plasma levels and processing of warfarin in the body.

Warfarin is also unique because of the VKORC1 enzyme, which controls the oxidation state of vitamin K. VKORC1 normally works to activate vitamin K as part of the normal process of blood clotting. Warfarin inhibits VKORC1, which reduces vitamin K oxidation and reduces clotting.

If a resident has lower levels of VKORC1, less warfarin will be needed to impact clotting. If this is not known and a resident receives a standard dose of warfarin, he or she may experience an increased risk of side effects, such as bruising and bleeding.

If pharmacogenetics were used, healthcare professionals would have cytochrome P450 and VKORC1 genetic information available to them when prescribing medications. This would allow for more appropriate doses of medication for the resident, tailored to his or her bodily processes, for more optimal results.

Pharmacogenetics and the Future

After using pharmacogenetics to gain a resident’s genetic information, it does not need to be repeated. The resulting data can be applied to the resident’s entire therapeutic regimen and taken into consideration before any future prescriptions to make his or her medication regimen specific and personalized.

Healthcare providers routinely encounter situations where things don’t work out as expected, or simply can’t be reconciled with medical training or experience. This is because of our unique human body, and factors we cannot detect.

Medical care of the future, armed with pharmacogenetics, will provide all that is needed to make optimal medication decisions for residents.

Pharmacy is always evolving, and Grane Rx works to stay ahead of the changes. We offer the Medication Insights™ program, powered by YouScript, to help identify potential interactions and offer alternative prescribing options. Visit our site to learn more or request a free analysis. ]]>

Rising medication costs are a significant concern nationwide and in skilled nursing. Today, prescription drug expenditures account for nearly 20 percent of healthcare costs, and prescription spending is growing faster than any other part of health care. Consider these facts:

This was the case at the Jewish Association on Aging, a network of senior care facilities in Pittsburgh, Pennsylvania. When they began working with Grane Rx several years ago, they felt like their pharmacy spend was out of control. Working with Grane Rx helped them regain control of their spending and cut costs significantly. [Tweet “The *right* #LTCpharmacyservices provider can help reduce pharmacy spend in #skillednursing.”]

Making the Transition to Grane Rx LTC Pharmacy Services

Several years ago, the decision was made at the Jewish Association on Aging to change providers to Grane Rx. As with any program, changing pharmacies is a huge undertaking. “Grane Rx staff were here throughout the transition, assisting with protocols, policies, procedures, and staff training,” says Mary Anne Foley, RN, MSN, Chief Operating Officer with the Jewish Association on Aging. “The transition and onboarding was very good. They had a team here that helped facilitate—they literally lived in the building.” While adapting to a new LTC pharmacy services provider can be difficult, often the problems come after the initial transition. That hasn’t been the case for the Jewish Association on Aging. “Over the years, Grane Rx has proven to be a true partner within our organization, providing ongoing support, education, and consultation to our staff, residents, and physicians,” Foley says. “Pharmacy staff have been incorporated into our Quality and Infection Control Committees and during this past year were instrumental in assisting with our organization-wide emergency management procedures.”

How Grane Rx LTC Pharmacy Services Made an Impact

Through a combination of competitive Grane Rx pricing and cost-cutting measures, the Jewish Association on Aging, which provides both skilled nursing and assisted living, saw a 12 percent decrease in pharmacy spend. That’s substantial on its own, but the Grane Rx LTC pharmacy services team also impacted the Jewish Association on Aging facilities in other ways.

Cost Reduction

Grane Rx did more than just offer lower prices on prescription medications. They also impacted positive change for the Jewish Association on Aging by helping them enact guidelines and procedures in-house. “We didn’t have a good process for the formulary,” Foley says. “Of course, our physicians, like most physicians, will just order anything, because they don’t really pay attention to costs.” Members of the Grane Rx team are regularly on site, brainstorming and helping with the process of reducing costs and realizing savings where appropriate. Because Grane Rx pharmacists were willing and able to sit and discuss the topic of formulary processes, they were able to explain the benefit of therapeutic interchanges to physicians. “When we transitioned to working with Grane Rx, our cost savings over the previous year were in the thousands,” Foley says. “They’ve worked with us on cost reduction and the creation of a formulary that our physicians buy into, which makes a tremendous difference.”  

Clinical Support

Beyond making a direct impact on pharmacy spend, Grane Rx also helps facilities prepare for surveys, compliance reviews, and continuing education. “They actually help prepare us for Department of Health surveys, for personal care and assisted living,” Foley says. “They do specific training—if we’ve identified specific issues, they’ll come work on those with us.” With the help of Grane Rx clinical staff, the Jewish Association on Aging nursing home achieved better than benchmark status on quality measures. In 23 out of 26 months, they earned a 5-star quality rating, and many of those measures are related to the use of medications, such as: Beyond these measures, Grane Rx also provides medication-related counseling and guidance designed to help keep residents out of the hospital—an area of focus for long-term care.

Emergency Management

Emergency management is an important area for LTC pharmacy services to contribute expertise and training. A Grane Rx pharmacist participates in emergency management meetings to help the Jewish Association on Aging scope out pharmacy’s role in emergencies. That assistance has made a noticeable impact. “In our home health division, both of the survey teams said that our emergency management plans were the best they’ve ever seen,” Foley says. Competitive pricing and cost-cutting measures can help you gain control of pharmacy spending. Get started working with our team today by calling (866) 824-MEDS (6337) or filling out this quick form.]]>

Participants, family members, and providers in the PACE environment should all be familiar with medications and medical conditions that increase the risk of falls. Medications—and their side effects—are one of the major causes of falls in the elderly. Because of the potential for injury when an older person falls, everyone in the PACE environment should be aware of which medications or conditions come with an increased risk of falls. When it’s possible, providers should seek safer alternative medications or even reduce medications to the lowest effective dose as a fall prevention strategy.

Medication Criteria in the PACE Environment

For more than 20 years, the American Geriatrics Society has provided a continuously updated resource for providers to improve the safety of older adults who take medications. The BEERS Criteria for Potentially Inappropriate Medication is the gold standard for prescribing safe medications for older adults in the PACE environment. As PACE participants grow older, their bodies change. Because of these body changes, older adults have a higher risk of unintended or exaggerated side effects from their medications. Each year, one out of three seniors aged 65 or older encounters at least one adverse medication reaction. While the BEERS Criteria is a valuable tool, it cannot be the only guide when prescribing medications for participants in the PACE environment. Different participants respond differently to the same medications. Experienced clinical judgement must be included in every prescription choice. [Tweet “Do you know what medications and medical conditions increase fall risk in the #PACE environment?”]

Anticholinergic Medications in the PACE Environment

Anticholinergic medications inhibit certain nerve impulses, thereby reducing spasms of smooth muscles like those found in the bladder. These drugs are used commonly among senior adults in the PACE environment. Some medications, such as atropine, benztropine, and oxybutynin, are used specifically for their anticholinergic properties, and others such as diphenhydramine, cyclobenzaprine, and olanzapine have anticholinergic properties unrelated to their primary use. Studies have shown that medications with anticholinergic properties can have adverse side effects like blurred vision, dry mouth, urinary retention, constipation, cognitive impairment, confusion, delirium, increased heart rate, and drowsiness. These conditions can significantly increase the risk of falls. The risk of falls increases when taking medications with strong anticholinergic properties, taking higher doses of these medications, or taking a combination of them. Adults in the PACE environment are also more likely to experience adverse events from anticholinergic medications because of bodily changes and preexisting conditions. When possible, medications with anticholinergic properties should be avoided in older adults unless they are absolutely necessary. If the medication is necessary, it should be used at the lowest dose for the shortest possible time. Providers in the PACE environment should also consider replacing such medications with alternatives, including non-medicinal solutions.

Falls in the PACE Environment

It may be impossible to eliminate falls altogether, but everyone should be concerned with reducing the risk of falls throughout the PACE environment. When a fall occurs, it is vital to evaluate the participant’s medications and determine what may have contributed to the fall. For example, if a participant recently suffered a fall, look through recent records and see if a medication dose has been increased, a new medication has been added, or if the participant has been requesting more of a medication that could contribute to a fall. By constantly reviewing each participant’s therapies, talking with family members, and creating action plans when a fall occurs, everyone concerned with the PACE environment can provide participants with the best care possible. Want to learn more about the impact Grane Rx can have on your PACE center and your services in the PACE environment? Start the conversation by calling (412) 449-0504 or emailing paceteam@granerx.com.]]>

In the long-term care setting, the fall incidence percentage is severe—almost 50 percent. As SNF residents age, this percentage rises. The incidence rate of falls (number of falls per 100 person years) increases from 47 in older adults ages 70–74 to 121 in those that reach age 80.

It’s well known that certain medications can increase fall risk—and that post-acute care pharmacy providers play a key role in mitigating that risk. Pharmacy providers must work alongside other members of the SNF’s multidisciplinary team to help lower fall risk among all residents.
Every healthcare provider knows that medication can contribute to falls, especially in older adults. Seventy-two percent of people ages 55 and older use at least one medication, with 20.3 percent of that group using four or more.

The high rate of medication usage in this population has led to a rise in adverse drug reactions (ADRs), a particular concern for long-term care providers, who are tasked with keeping residents out of the hospital.
With a growing aging population who are being prescribed an increased number of medications, an interdisciplinary approach to fall management is vital.

Pharmacists are uniquely equipped to lend their medication expertise to the rest of the care team in order to improve resident outcomes. Let’s explore how pharmacists and post-acute care pharmacy professionals can contribute to an interdisciplinary approach to fall management.

Post-Acute Care Pharmacy Can Help Educate Residents About Medications

Healthcare professionals often assume that residents have been educated on and, as a result, understand their medications. Many healthcare providers lack the time to adequately educate residents on their medications and disease states.

The post-acute care pharmacy team can help solve these medication-related issues—they’re considered the most accessible healthcare professionals and have an intimate knowledge of medications and the potential issues they pose to residents. This knowledge can be transferred to both other members of the care team and SNF residents.

Through medication reviews and therapy management, long-term care pharmacy providers are able to reduce the chances of an older adult falling due to medication. As the pharmaceutical industry innovates, both the medications and the standard of care for disease states have become more complicated.

Resident education about both disease state and medications has taken on increased importance. Residents and care team members need to understand the purpose of each medication, its potential adverse reactions, and which medications can increase the risk of falling.

Utilizing post-acute care pharmacy services as part of your interdisciplinary approach to fall management can help provide residents with more educated supervision and care. Team members know the fall risk factors for each resident and can take steps to reduce those risks.

An issue that is especially felt in the long-term care setting is the transition of care. Poorly executed transfers of older residents from hospitals to the long-term care setting, from long-term care setting to long-term care setting, or from the long-term care setting to home carry the risk of fragmentation of care, poor clinical outcomes, inappropriate use of emergency department services, and hospital readmission.

Utilization of post-acute care pharmacy services and medication management can help provide residents with a more complete transition and help to reduce some of the errors seen in resident transition, specifically in regards to medication.

Post-Acute Care Pharmacy Can Help Monitor Polypharmacy

A major issue, especially regarding medication-related falls, is polypharmacy, or the use of multiple medications. Polypharmacy is prevalent among older adults, including those in the long-term care setting.
The Centers for Medicare & Medicaid Services implemented a quality indicator measure that targets residents on nine or more medications. A study that utilized this information found that 39.7 percent of SNF residents had polypharmacy as defined by the quality indicator measure. Residents age 85 and older represented the group with the lowest rate of polypharmacy, with nearly 35 percent of this group taking nine or more medications.

Polypharmacy has many far-reaching negative consequences, contributing to healthcare costs for both the resident and the healthcare system. There is an associated increased risk of taking a potentially inappropriate medication, an increased risk of outpatient visits, and an increased rate of hospitalization.

Post-acute care pharmacy team members can and must work with the other SNF team members to educate them on these consequences and risks—and how to mitigate them.

Polypharmacy also contributes to an increased rate of adverse drug events. In SNF residents, the rate of adverse drug events is twice as high in residents taking nine or more medications compared with those taking less.
Medication non-adherence has been associated with complicated medication regimens and polypharmacy, and can lead to potential disease progression, treatment failure, hospitalization, and adverse drug events. Polypharmacy has also been found to contribute to falls. A study found that the risk of older adults experiencing a fall rose 7 percent for each additional medication they are prescribed.

At Grane Rx, we’re committed to providing SNF residents with the utmost care—and that includes an interdisciplinary approach to fall management, including post-acute care pharmacy services. Get started working with our team today by calling (866) 824-MEDS (6337) or filling out this quick form.

Food, liquids, and medications are absorbed, distributed throughout the body, metabolized, and then eliminated. This is accomplished through a complex and complicated process involving a host of your body’s enzymes. Obviously, knowing how slow or how quickly a medication is metabolized and eliminated from the body is crucial when prescribing medications for health issues. When multiple medications are involved, as is the case with the average PACE participant, the issue becomes even more complicated. Let’s take a look at the role medication metabolism plays. [Tweet “When multiple meds are involved, medication metabolism becomes an important issue. #PACEpharmacy”]

Medication Metabolism & the PACE Participant

Most medication metabolism occurs in the liver, kidneys, and small intestine. Water-soluble, or hydrophilic medications, are more readily excreted by the body. Conversely, it is more difficult for fat-soluble, or lipophilic medications, to be eliminated without being changed.
Therefore, extremely water-soluble medications may bypass metabolism in the liver and be eliminated completely unchanged by the kidneys. And a largely lipid-soluble medication may undergo numerous phases of metabolism in order to provide a compound that can be excreted by the body. The basic understanding is:

It is commonly, and incorrectly, believed that all medications require extensive metabolism.
The human body is highly efficient, and only conducts those metabolic processes that are necessary. The amount and types of reactions depend on the individual’s body chemistry and the chemical structure of the medication.

Factors Affecting Medication Metabolism in the PACE Participant

A person’s genes dictate how the body functions. This affects the enzymes that metabolize medications.

A PACE participant may metabolize poorly, another about average, and yet another quite efficiently. This will affect how quickly a medication is used and eliminated from the body.

There are other factors that affect medication metabolism. There is some evidence in animals and humans that drug metabolism diminishes with age, although the effect has not been well studied.

A PACE participant of advanced years may have more difficulty metabolizing certain medications than younger participants.
Hereditary or genetic factors can play a part in how the PACE participant metabolizes medications—and especially certain combinations of medications. Some may enjoy a genetic predisposition to metabolize complex substances rather rapidly and without complications, while others may struggle to break them down for longer periods of time.

In humans, there have been a few reports of gender differences in metabolism. For instance, nicotine and aspirin seem to be metabolized differently in women and men.

On the other hand, gender differences can become significant in terms of drug-drug interactions based on the drug’s metabolism.

Pharmacy Solutions for the PACE Participant

In order to protect against unwanted adverse medication reactions, doctors and PACE pharmacy providers would want to choose a medication that is metabolized adequately by the individual. Clearly, knowing the health background and medical condition of each PACE participant is crucial to providing quality pharmacy solutions.

Want to learn more about the impact Grane Rx can have on your PACE center and your services to the PACE population? Start the conversation by calling (412) 449-0504 or emailing paceteam@granerx.com.

Deoxyribonucleic acid (DNA) determines the color of our hair eyes. It dictates how tall we will be and even how we will respond in certain situations. In essence, DNA completely makes up a human being. So how does this occur?
When conceived, an unborn child inherits 50 percent of the father’s DNA and 50 percent of thee mother’s DNA. Obviously there is no choice as to which parent’s DNA will affect what, but in the strictest sense, a child is one half of either parent.

DNA is a self-replicating material present in nearly all living organisms that is the carrier of genetic information. Not all DNA is accessible at a single point in time. Therefore, your body only accesses the specific areas that it needs. A specific region of DNA that codes for a specific product is called a gene.

For example, if your body needed to make more clotting factors due to a bad bleed, your body would access the gene responsible for providing the template for these proteins and would make them based upon the blueprint. Human beings have approximately 24,000 genes.

This is important to know in the field of medicine. Your unique DNA causes your body to metabolize certain medications differently. The specific area that focuses on this phenomenon is the field of pharmacogenomics.

Grane Rx offers pharmacogenomic testing through the Medication Insights program. But how can pharmacogenomics impact medication regimens for long-term care residents? Read on to explore the issue.

Pharmacogenomics and Post-Acute Care Pharmacy

Pharmacogenomics (Pgx) is the study of how genes affect a person’s response to medications. Until recently, medical experts thought that medications were a “one-size-fits-all” solution. For example, if a certain amount of a drug taken daily prevented clotting around a stent in individuals in clinical trials, then it was thought to do the same in every other individual.

Pharmacogenomics has disproven this phenomenon. Depending upon an individual’s genes, he or she may benefit, not respond, or be negatively affected by certain types of pharmacotherapy.

So the question then becomes, how do we know how a person will respond?

Medication Response in Post-Acute Care Pharmacy

Without testing to confirm an individual’s genetic makeup, doctors cannot be sure how he or she will respond to certain medications. Fortunately, genetic testing is now an efficient and cost-effective exercise.

Testing and analysis have become so streamlined that the generated report will advise a practitioner to consider an alternative, proceed with caution, alter a dose, or continue therapy unchanged.

This means that Pgx testing can truly personalize post-acute care pharmacy for every individual. With the results, providers can maximize benefits and minimize negative outcomes.

The already reasonable cost of pharmacogenomics testing can be offset by preventing an unnecessary hospitalization one time in a person’s life.

This is relevant for residents of Skilled Nursing Facilities as adverse effects of medications are more pronounced in the elderly population. Those that require assisted living are usually taking multiple medications for various disease states.

Therefore, using the information from Pgx can personalize their medicine and decrease the number of medications they take, the number of side effects they experience, and any doubt that they may have regarding the efficacy of a certain medication.

The Grane Rx team works with Skilled Nursing Facilities to design and implement medication safety and care transition processes. Could your SNF benefit? Call (866) 824-MEDS (6337) to find out more.

The ultimate goal of PACE, including PACE pharmacy, is to provide members of the PACE population with high-quality care that keeps them independent and active, allowing them to remain in the home while receiving the services they need. An essential element of such services is medication reconciliation.

Medication Changes in the PACE Population

Older adults are often on multiple medications—and these medications are often stopped and new medications ordered, as medications are changed over time. Medication changes can cause confusion for members of the PACE population, for caregivers, and for participants’ family members. Lack of communication between PACE participants and healthcare providers during care transitions contributes significantly to medication safety errors. That’s why it’s vitally important for PACE pharmacy providers and other members of the multidisciplinary team to thoroughly review these changes with participants and their caregivers, ensuring they understand what is happening and why.

Reconciling Medications in the PACE Population

With an increased number of medications—which are often prescribed by multiple physicians, including specialists—comes an increased number of potential problems. Side effects, possible duplicate therapies, and the possibility of drug interactions are just some of the serious issues that can arise.

Clinical consults play an important role in ensuring safety among the PACE population. These consults, in which a geriatric-specialized pharmacist reviews participant medications on a regular basis, include a number of safety checks, including:

  • PACE medication regimen reviews
  • Reviews following a clinical change of status or emergency room visit
  • Elimination of duplicate medications
  • Identification of potential drug-drug interactions

Clinical consults serve a dual purpose: They help promote positive outcomes for members of the PACE population, while helping PACE centers contain costs and make efficient decisions.

Coordination of Care in the PACE Population

Communication and participant/caregiver engagement are essential to ensure all parties are working from the same plan. PACE pharmacy services work along with all members of the participant’s multidisciplinary medical team to ensure continuity of care.  

This integrated model of care aims to improve the quality of life of participants within the PACE population with chronic care needs by providing necessary medical and pharmacy services, including medication reconciliation.

Medication reconciliation, part of the clinical consult, carefully reviews a participant’s medication regimen, lowering the risk of preventable medication errors and potential hospitalization.

Literacy Education and Labeling Options for the PACE Population

Health literacy education is designed to ensure each participant understands his or her therapies—taking into consideration hearing, vision, or physical impairments; language barriers; and/or the ability to understand written text.

Optimal, effective medication management for the PACE population utilizes both written and visual tools, along with health literacy information, to help participants and their family members understand their medication regimens.

Grane Rx partners with PACE centers to provide participants with medications that are delivered directly to the home in easy-to-understand packaging that includes clear directions on when medications should be taken. The packaging also includes both visual and written cues on what medications are for, as well as how they should be taken.

These tools, in combination with medication reconciliation, help limit the risk of avoidable drug errors and other potential problems.

Want to learn more about the impact Grane Rx can have on your PACE center and your services to the PACE population? Start the conversation by calling (412) 449-0504 or emailing paceteam@granerx.com.]]>

Care transitions are one of the times when a resident’s risk of potential medication errors significantly increase. An estimated 80 percent of medical errors occur during the transition between medical providers. Of those errors, 40 percent involve medications, and 20 percent result in harm to the resident. The challenges to medication safety during care transitions must be identified and overcome for the sake of residents and their overall quality of care. The following are some primary areas in which to begin. [Tweet “Overcoming the challenges of #medicationsafety during care transitions. #longtermcarepharmacy”]

Better Communication for Medication Safety

Communication breakdowns, or miscommunication, can be one of the biggest challenges that affect medication safety during care transitions. And yet, knowing this is true, extra care should be taken during this pivotal time to communicate everything necessary regarding medications to all involved parties. Healthcare providers must have a system of regular communication so that the needs of incoming SNF residents can be prepared for ahead of their transition. At least 24 hours is usually required to facilitate special equipment or monitoring needs. Moreover, every time the slightest change is made to a resident’s care plan, especially regarding medications, this change should be communicated to all involved parties, including the resident and his or her family support team. Ideally, a provider team member will be charged with the responsibility of managing medication safety and the communication of a resident’s care plan to all involved parties.

Current Information for Medication Safety

Healthcare providers and care facilities must strive to ensure each has up-to-date data on each resident for medication safety. Conflicting, outdated, or inaccurate information can result in serious harm to the resident, especially when concerning medications that have since been discontinued or replaced. Electronic data that is synchronized across every involved healthcare provider can go far to maintain up-to-date resident information that is immediately accessible. This can keep discrepancies from arising in resident care, as well as limit lost time when access to a provider is not immediately available.

Resident-centered Discharge Planning for Medication Safety

Serious miscommunications during care transitions occur when the resident is unclear or confused about the decisions made for his or her health. Resident-centered discharge planning and education about medication safety that involves the entire patient support system will ensure that residents and families are informed and in agreement with medical decisions. This may necessitate performing a literary assessment with the resident to ascertain his or her level of understanding before communicating any medical information. Using terminology and phrasing that a resident understands breeds confidence in the medical team and their decisions for care.

Patient Support System Involvement for Medication Safety

A resident’s patient support system can be an invaluable asset to involve with care transitions, especially when striving to ensure medication safety. Family members who are actively involved are more likely to have a positive impact on the resident’s overall health outcomes. These family members must be taught their roles and the importance of their part in medication safety and overall care. Always try to provide printed resources for the patient support team to keep for later reference, especially concerning their loved one’s medications. Transitions of care can be confusing and difficult times for providers, staff, residents, and families, especially regarding medication safety. That’s why it is important to have effective communication, accurate information, patient-centered education, and patient support system involvement during transitions. A proactive approach to medication safety during transitions can help providers and staff facilitate safe and smooth care transitions. The Grane Rx team works with Skilled Nursing Facilities to design and implement medication safety and care transition processes. Could your SNF benefit? Call (866) 824-MEDS (6337) to find out more. ]]>

Many PACE participants have multiple disease states that require numerous medications. This leads to complex medication regimens consisting of multiple medications—what we in the industry refer to as polypharmacy. Without oversight, polypharmacy in seniors can be a significant problem, as taking multiple medications at one time increases the risk for adverse reactions. That’s why Medication Regimen Reviews (MRRs), provided by consultant pharmacists, are essential when administering medications to those in the PACE population. These reviews help prevent drug interactions and promote medication adherence among PACE participants.

Polypharmacy in PACE Participants Impacts Medication Adherence

When PACE participants take multiple medications, it’s not uncommon for medication adherence to decline. It can be difficult for anyone to keep up with numerous medications and instructions. Additionally, packaging that’s difficult to read, understand, or open for seniors can also lead to a lack of medication adherence. Regardless of why seniors fail to adhere to their medication regimens, the fact remains that with an increased number of medications comes an increased number of side effects, the potential for duplicate therapies, and the possibility of drug-drug interactions. Grane Rx partners with PACE centers to provide clinical consults, in which a specialty pharmacist reviews participant medications on a routine basis. These pharmacy consults serve two important purposes: promoting positive outcomes for PACE participants while helping PACE centers contain costs and make efficient decisions. Let’s take a look at the role of pharmacy consults—specifically, regular MRRs—in limiting polypharmacy in participants.

Polypharmacy in PACE Participants and the Role of Medication Regimen Reviews

A thorough MRR is necessary not only when participants are accepted but also throughout the duration of their medication therapy. In a nutshell, these reviews are one of the most important steps that PACE centers can take to help eliminate unnecessary medications, and ultimately, the incidence of adverse reactions. It’s important to determine why a participant is using a particular medication and to match each medication to an appropriate diagnosis. Often, medications are associated with one of three types of diagnoses: In these cases, clinical judgment should be utilized to determine whether the off-label use is appropriately supported based upon the participant’s medical history and if the benefits of therapy outweigh the risks of adverse effects. Another important practice for preventing polypharmacy is optimizing medication regimens when more than one agent is being used to treat a condition. A common example of this is the use of multiple agents to manage hypertension in participants. It’s not uncommon to see as many as four or five antihypertensive medications ordered for the same participant. One of the fundamental guidelines in treating a disease state that may require more than one medication is to start with one medication and maximize the dose until either the maximum recommended dose is reached or the maximum dose without adverse effects is reached. Once the maximum dose has been reached, an additional agent can be used and titrated if better control is needed. PACE participants on multiple medications at suboptimal doses should have their regimen evaluated and, if clinically acceptable, have a medication discontinued while adjusting the doses of the other medications.

Medication Regimen Reviews: Best Practices That Limit Polypharmacy in PACE Participants

MRRs are a major point of concern in recent years surrounding medication management in seniors. As part of CMS’ new Final Rule, for example, a major focus will now be on preventing or minimizing adverse consequences in skilled nursing residents related to medication therapy.   While the new regulations don’t apply to PACE pharmacies, they can still apply the following best practices to help reduce the incidence of polypharmacy and adverse medication-related reactions in participants: Acute status change reviews can be requested by completing and faxing the Medication Regimen Review Request Form to the pharmacy. Results of the review will be provided to the patient’s facility within three business days of the request. Any irregularities and/or clinically significant risks from medications will be documented in the participant’s medical record and recommendations related to the irregularity will be made to his or her physician. In addition, a separate report detailing all irregularities identified during the consultant pharmacist’s reviews for the month will be provided to the participant’s prescribing physician each month. While polypharmacy in seniors itself isn’t a problem, the inherent risks are. That’s why it’s essential to review medication regimens to ensure participants are properly managing and taking their prescriptions. Want to learn more about the impact Grane Rx PACE pharmacy services can have on your PACE center? Start the conversation by calling (412) 449-0504 or emailing paceteam@granerx.com.]]>

In 2016, the Centers for Medicare & Medicaid Services (CMS) introduced the Final Rule, a set of new regulations that significantly impact LTC pharmacy services. The most taxing phase of the Final Rule, Phase 2, went into effect just a couple months ago, in November 2017. While Phase 1 introduced a number of important medication-related changes that affect LTC pharmacy and residents, Phase 2 is far more complex, involving several pertinent medication-related topics. Before the implementation of Phase 2, we explored the implications of some of the coming medication-related changes concerning psychotropic medications in particular. But to ensure you’re prepared for the new year, we wanted offer an updated, in-depth review of some of the most fundamental medication-related changes. Let’s take a look.

Final Rule Phase 2’s Impact on LTC Pharmacy Services: New Regulations Regarding Crushed and Enteral Tube Medication Administration

As organizations have been preparing for Phase 2 changes, the administration of crushed and enteral tube medications has been a hot topic. Best practices indicate that crushed medications should not be combined and administered all at one time, either orally or via feeding tube. As such, the advanced copy of Appendix PP and Surveyor Guidance indicates that SNF staff members are to administer each crushed oral medication separately. So each medication being administered to residents would be delivered, for example, in a separate applesauce or pudding supply. While CMS believes this practice to be the standard, many in the industry hold that CMS’ approach may not be ideal for all residents. Because of this, failing to administer these medications separately will not be considered a medication error unless specific instructions about crushing and administering the medication are not followed. To stay in compliance with the new regulations, it’s important for Skilled Nursing Facilities to keep the following updates top-of-mind when administering crushed and enteral tube medications: With that in mind, a facility is not required to flush between medications if there is a physician’s order that either specifies a different flush schedule due to fluid restriction or specifies the amount of water to be used for flushing due to fluid regulation. If the prescriber orders a medication to be crushed and the manufacturer states that the medication should not be crushed, the prescriber or pharmacist must explain in the resident’s clinical record why crushing the medication will not adversely affect the resident. Moreover, the pharmacist should inform the facility staff to observe the resident for adverse effects. This will be addressed through the Medication Regimen Review process, which we’ll cover momentarily. The new standards for the administration of these medications are to ensure the safety of the resident and prevent adverse effects from combining multiple medications. Because these updates focus on providing person-centered care, it’s encouraged, when possible, to separate crushed medications to provide the best resident care.

Final Rule Phase 2’s Impact on LTC Pharmacy Services: Medication Regimen Review Changes and Recommendations Follow-up

Many long-term care residents have multiple disease states that require numerous medications. This leads to medication regimens that are complex and have the potential to increase residents’ risk for adverse reactions. One way to potentially minimize these adverse reactions is to use a Medication Regimen Review, provided by a consultant pharmacist. These reviews may help prevent drug interactions as well as help identify omissions, duplications of therapy, and miscommunication between care providers. There are two key focus points of Phase 2 changes to the Medication Regimen Review requirement:
  1. Helping residents maintain their highest level of function
  2. Preventing or minimizing adverse consequences related to medication therapy
To be compliant with these integral changes, facilities will need to provide the following: All admissions, including residents not expected to be in the facility for more than 30 days, will be reviewed by the consulting pharmacist. Any findings for new admissions or re-admissions will be sent to the Director of Nursing within seven business days of admission. Acute status change reviews can be requested by completing and faxing the Medication Regimen Review Request Form to the pharmacy. Results of the review will be provided to the facility within three business days of the request. Any irregularities and/or clinically significant risks from medications will be documented in the resident’s medical record and recommendations related to the irregularity will be made to the resident’s attending physician, the nursing staff, or the pharmacy. A separate report detailing all irregularities identified during the consultant pharmacist’s reviews for the month will be provided to the resident’s attending physician, the facility Medical Director, and the Director of Nursing each month.

Final Rule Phase 2’s Impact on LTC Pharmacy Services: Guidelines for Psychotropic Medications

A psychotropic medication is any medication that affects brain activities associated with mental processes and behavior. Antipsychotics, antidepressants, anxiolytics, sedatives, and hypnotics are some examples of the different categories that psychotropic medications can fall under. Until recently, CMS’ focus has primarily been centered around antipsychotic medications. However, with the new regulations in place, the focus will now shift to all psychotropic medication classes. The required provisions of the CMS Final Rule Phase 2 aim to reduce or eliminate the need for psychotropic medications, if not clinically contraindicated, to safeguard residents’ health. National prevalence of antipsychotic use for long-term care residents has fallen, but for providers that still have a high rate of use, CMS has identified a new goal of a 15-percent reduction in antipsychotic use by 2019. With this new focus on reducing antipsychotic medication rates, those in the industry will notice a marked shift toward the use of nonpharmacologic approaches and person-centered care practices. As such, according to the Final Rule, when prescribing psychotropic medications based on a comprehensive assessment of a resident, the facility must ensure that:
  1. All residents who have not previously been prescribed psychotropic medications must have a specific condition requiring the use of the medication and have that condition or diagnosis documented in the resident’s clinical records.
  2. Residents already taking psychotropic medications should receive gradual dose reductions and nonpharmacologic interventions, unless clinically inappropriate, with the goal being to eventually discontinue the medication.
  3. Residents who require psychotropic medications on an as-needed (PRN) basis must have documentation in their clinical record of the specific condition that requires the use of the medication.
  4. PRN psychotropic medications are limited to 14 days. If extended therapy beyond 14 days is required, the prescriber must document the reasoning in the resident’s clinical record and indicate the new duration of use.
  5. All PRN antipsychotic medications are limited to 14 days. If there is a clinical reason to continue the order, the prescriber must evaluate the resident for appropriateness and write a new order that will be limited to another 14 days. This process must be repeated with each subsequent order.
The Grane Rx team works hard to stay in-the-know on regulatory and guideline changes as they relate to LTC pharmacy services, and put that information into action. Could your SNF benefit from our services? Call (866) 824-MEDS (6337) to find out more. ]]>