Review of Medication Distribution on Recreation Outings

1. Review of Medication Distribution on Recreation Outings Prepared for the SWO Stroke Recreation Therapist Network Workshop Kim Durst-Mackenzie October 8, 2009

2. Presentation Topics • Brief overview of current policy. • Risk issues & challenges with current Policy & Procedure. • Facts & Data. • Options.

3. Current Policy • Therapist/Technician can administer oral meds (10% Therapist/90% Technician) when on outings. • RN/RPN prepares medications and instructions (envelopes) and gives to TRS staff. • If meds are prescribed at times +/- 1 hour of trip, then meds taken on the outing. • For the last few years (given increasing pt. complexity) now very few self meds; TRS staff administer most meds. • RN/RPN informs TRS staff re: new patients and or new prescriptions. • Same policy and procedure for LTC and SVH/EBH.

4. Current Issues From the TRS perspective • In approx. 25% of cases, the content and instructions of the envelopes are inconsistent. • Crushed medications (for pts with swallowing problems) are not always prepared properly. • Potentially serious patient safety issues. • Double patient identifier process was not in place.

5. Current Issues Medication administration not in the TRS “scope of practice”. Administering a substance by inhalation (eg. puffer) is a nursing controlled act under the RHPA. TRS Technicians may lack training and experience to determine the risk of medication administration. Serious potential professional and organizational liability risks.

6. 1 Month Data Snapshot November 2008 Survey Total Outings# pts who got meds • SVH outings = 18 19 patients • EBH outings = 0 0 • EBR outings = 4 15 patients • RSL outings = 2 9 patients Total = 24 43 patients

7. What medications are being distributed? Typical EBR outing (LTC) 80% of participants get meds • Tylenol, puffer • Tylenol • Metformin, Baclofen, puffer • Tylenol, Calcium, puffer • Tylenol, Morphine • Metformin, Dilantin, Lactulose, Diclectin, puffer • Aspirin, Tylenol, puffer • Domperidone, Tylenol Typical SVH outing (CCC) 10 – 43 % of participants get meds • Domperidone • Tylenol, Clozapine, Metformin, Salmon Oil and Codeine • Baclofen • Sinamet

8. Do TRS staff elsewhere administer meds? YES NO YES NO FACILITY Terrace Lodge St. Joseph’s Health Care St. Thomas Elgin Hospital Hotel Dieu Shaver Health Rehab Lake Ridge Health Corp. People Care Tavistock Hamilton Health Rehab Grand River Hospital – Freeport Chatham-Kent Health Brantford General Hospital Bluewater Health FACILITY City of Ottawa (4-LTC) Montfort Hospital The Ottawa Hospital Royal Ottawa Hospital Toronto Grace Hospital Waterford (LTC) Sudbury Regional Hospital Windsor Regional Hospital Niagara Health, Welland Hospital North Simcoe Hospital Providence Health Care √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ Totals: YES = 11 NO = 11 Like Facilities: YES = 6 NO = 4 LTC: YES = 4 NO = 2

9. Discussion • How do we balance patient safety, organizational and professional liability and patient quality of life? • D/C TRS staff administering all meds on outings • Build outing schedule around medication times instead of the other way around. • Include RPN on outings. • Have a “pill vacation” • Do the benefits outweigh the risks?

10. Policy Revision • Interprofessional approach to policy revision • Recreation Therapist, Physician, Advanced Practice Nurse, Clinical Manager, Pharmacist • Clearly delineate scope of practice issues and any acceptable conditions for delegation • Address procedural issues (e.g. determine how to reliably flag patients scheduled for outings who have had a change in prescription). • Provide education and training • Nursing and Therapeutic Recreation Services