BID Med Pass Project Michael D. Crowley, MD, FAAFP,CMD Joan Gannon, RN, CDONA/LTC

1. BID Med Pass Project Michael D. Crowley, MD, FAAFP,CMD Joan Gannon, RN, CDONA/LTC Stacey Radcliffe, MGS, NHA The Pines Center Genesis Healthcare Corporation Long Term Care Medicine – 2011March 24-27, 2011Tampa, Florida

2. Unchain Your Nursing Staff!!

3. Learning Objectives: • Describe the value of a BID Med Pass System • Explain how the clinical team can accomplish this initiative • List ways this process can • Increase compliance with regulatory codes • Enhance staff performance • Positively affect every day routine for staff • Increase staff and resident satisfaction

4. BID Med Pass – Project Definition A BID Med Pass Schedule is developed to consolidate medication administration times for long term care patients, where clinically appropriate, to minimize unnecessary medications and the numbers of medications which require administration outside this schedule.

5. Quality Improvement / Quality of Life Project • How many times do we approach a resident for medication administration? An example: • Colace 2x/day: 9am & 5pm • Seroquel at bedtime: 9pm • Nifedipine qd: 9am • Alphagan tid: 6am-2pm-10pm • Natural Tears qid: 6am-12pm-6pm-12am • 6am-9am-12pm-2pm-5pm-6pm-9pm-10pm 8 times / day

6. Quality Improvement / Quality of Life Project • Decrease daily interruptions for the residents • Improve sleep • Fewer therapy or activities interruptions • Reduce “wait around” time for med administration • Increase nursing time spent for • non-medication related care and time spent with residents • supervision and support of staff • Reduce unnecessary meds / ADR potential • Increase Resident and Family Satisfaction

7. BID Med Pass – How did we do it? Achieving success requires • Team effort • Administrator • Director of Nursing/Assistant Director of Nursing • Medical Director, Nurse Practitioner, Attending Physicians • Consultant Pharmacist • Nursing Staff and Certified Medication Aides • Regional Clinical Services Manager • Measured approach – one unit at a time • Communication with all stakeholders

8. BID Med Pass – How did we do it? • Review each patient’s Medication Record for • Rescheduling meds according to new med pass times • Duplicate drug therapy, ineffective drugs • Safe changes of TID and QID orders to long acting BID dosage forms, if available • Reschedule BID, TID and QID orders to maximize overlap • Close review of drug regimens to eliminate unnecessary drugs/dose, ensure gradual dose reductions • Optimize resident specific needs, eg. timing of tube feeding • Close and constant collaboration with physicians • Pre-change Discussion; Chart Documentation • Follow up with effect of change (+ and -)

9. BID Med Pass: Our Example • How many times do we approach a resident with medication administration post BID Med Pass? • Seroquel at bedtime: 9pm • Nifedipine qd: 9am • Change BID Colace to Senna plus at bedtime: 9pm • Change Alphagan tid times: 9am-2pm-9pm • Decrease Natural Tears to tid: 9am-2pm-9pm (eliminate 12pm dose) • 9am - 2pm - 9pm Reduced from 8 to 3 times per day

10. Results of Our Efforts • Three LTC Units – 115 Residents • 101 Medication Regimens Converted or Consolidated to a BID Schedule • 88% Conversion Rate • Remember - All medications may not “fit”

11. Results of Our Efforts – Rx #s

12. Results of Our Efforts – Staff Time

13. BID Med Pass Benefits • Regulatory Compliance – Recent Survey Results • Quality of Patient Care Services – Improved Customer Satisfaction by 8% • Positive Resident Council Reports • Care Giver Model Initiated with Additional Staff Hours • Enhanced Dining Program • Improved Staff Satisfaction by 12% • SUCCESS!

14. BID Med Pass – Not a Financial Improvement Project BUT Project Implemented April - June 2010 • Avg Medication Cost Per Pt Per Month • 6 Mon Avg Ending June 2010 = $419/Pt/Mon • 6 Mon Avg Ending Dec 2010 = $308/Pt/Mon • ↓ $110 Avg Medications Cost per patient per month *Order data includes all payors (medicaid, medicare, insurance, pvt pay)

15. A smile says it all!

16. Questions?