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Medication Management in Assisted Living

Medication Management in Assisted Living. Lessons from Current Research. 85%. of assisted living residents require assistance with medications. NCAL. NSRCF First time national assisted living data collection effort by the CDC/NCHS/ASPE www.cdc.gov. NCAL

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Medication Management in Assisted Living

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  1. Medication Management in Assisted Living Lessons from Current Research

  2. 85% of assisted living residents require assistance with medications NCAL

  3. NSRCF First time national assisted living data collection effort by the CDC/NCHS/ASPE www.cdc.gov

  4. NCAL Assisted Living State Regulatory Review 2012 – www.ncal.org

  5. CEAL • Nonprofit collaborative of 11 national organizations: • Alzheimer’s Association, AALNA, AAHSA, AARP, ASHA, ALFA, CCAL, NCAL, NCB Capital Impact, PVA, Pioneer Network

  6. Background Research Challenges Recommendations

  7. Older adults take an average of 5 prescription medications per month CEAL

  8. Those with 3+ chronic health conditions Average 6-7 prescription medications per month CEAL

  9. Assisted Living Residents 10 routine medications per day 3 PRN medications per day

  10. state regulations are all over the map

  11. 10 statesutilize nurse delegation

  12. 20 statesallow unlicensed assistive personnel to administer medications

  13. 20 statesrequire “assistance with self-administration”

  14. “assisting with self-administration” a regulatory play on words

  15. Background Research Challenges Recommendations

  16. Observational Study: Oregon Health and Sciences Institute, Rutgers, University of Washington, and Northern Illinois University

  17. 28.2% medication error rate in assisted living

  18. 70.8% of medication errors in AL are related to dose timing

  19. 8.2% error rate when “time” errors are removed

  20. No errors were judged highly likely to cause harm (out of 1373 errors)

  21. CEAL/UNC Research:

  22. 35% of medication administrations involved an error

  23. 71% of errors were again related to dose timing

  24. < 3% of errors had moderate to significant potential for harm

  25. Med Techs did NOT have a higher error rate than nurses

  26. Written test results “predicted” likelihood of errors

  27. Background Research Challenges Recommendations

  28. Challenges:Large volume of routine medications

  29. Challenges: PRN Medications

  30. Challenges: Injections

  31. Challenges:Healthcare providers who do not specialize in geriatrics

  32. Background Research Challenges Recommendations

  33. Focus on high-riskmedications

  34. 1/3 of emergency room visits by older adults presenting with ADE are caused by 3 drugs: • Warfarin • Insulin • Digoxin

  35. CEAL/UNC Research Showed majority of errors with potential for harm related to: • Warfarin • Insulin • Risperidone

  36. Warfarin • Monitor for s/s of bleeding • Coordinate lab tests • Monitor OTC use

  37. Insulin • Follow delegation procedures • Monitor residents who self- administer

  38. System Redesign Consistency in medication management regulations across states

  39. System Redesign Improve training of unlicensed assistive personnel

  40. System Redesign Streamline documentation, perhaps through use of electronic health records

  41. Individualized Medication Plans Promote person-centered care in all aspects of resident care

  42. Individualized Medication Plans Tailor medication schedule and use of PRN medications

  43. Individualized Medication Plans Based on resident decision-making capacity, needs, and lifestyle choices

  44. Josh Allen, RN Care and Compliance Groupjallen@careandcompliance.com

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