According to the National Institutes of Health, those older than age 70 are 3.5 times more likely than younger individuals to be admitted to the hospital due to adverse drug reactions associated with psychotropic medications.
While that stat may be shocking, it should be no surprise that medication management plays a large role in clinical and resident-centric care.
Improved medication management processes combined with senior care organizations’ electronic health record (EHR) and e-prescribing tools can better protect residents, but also help meet care quality goals and drive performance improvement initiatives.
Safer and efficient medication management should be an enterprise-wide quality goal, which will require information technology tools to be accessed at any location across the senior care organization, or the medical practice or home of the prescriber, when necessary.

Collaboration Necessary

Similar tools have allowed organizations to drastically reduce the number of residents’ current prescriptions, improving safety and medication adherence. Quality improvement efforts such as better medication management, however, are less likely to be successful without collaboration among organizational leaders, staff providers, and external physicians whose prescribing behaviors may need to be modified.

When presented with verifiable data in this regard, prescriber behavior discussions are often more productive and can result in eliminating unnecessary medications and improving outcomes.

Reducing potential inappropriate medications (PIMs) is not just about reducing hospitalizations, although that itself is a worthy quality improvement goal. Reducing PIMs is also a significant quality issue among residents due to the increased chances of drug-drug interactions associated with “polypharmacy” situations and the improved medication adherence associated with reducing the number of medications.

From a cost perspective, prescription medications constituted $271 billion of the $2.9 trillion the Centers for Medicare & Medicaid Services (CMS) spent in 2013, the agency reported. CMS attributes the 2.5 percent medication spending growth that year to new medicines and increased utilization, both of which could be impacted by reducing PIMs.

One study shows that almost 40 percent of older adults in the United States take five or more prescription medications per month. Up to one-quarter of these prescriptions may be PIMs. This study also found that electronic-data analysis and electronic decision support tools positively impacted physician prescribing habits and, on average, eliminated two PIMs in the senior population studied.

Linking Systems

As senior care organizations are discovering, however, it is crucial that EHR and e-prescribing systems are linked across communities. Ineffective medication monitoring can be partly attributed to health information technology that is neither integrated nor interoperable. Linked information systems allow for rapid medication reconciliation, drug-allergy and potential drug-drug interactions, and side-effect notifications, all delivered within the physician’s workflow at the point of prescribing.

More advanced, integrated e-prescribing systems include simplified screens for order entry tailored to physicians’ preferences to allow for quick check-ins and streamlined entry for medication, imaging, lab, treatment, and diet orders. These tools can improve resident safety and streamline documentation for accurate, easy reporting and can significantly reduce or eliminate medication-related errors.

Moreover, improved safety reduces liability and regulatory compliance exposure for the senior care organization. For optimal safety, the system should be certified with Omnicare, Pharmerica, Prescribers Connection, and SoftWriters, giving the senior care organization access to accurate, real-time exchange of pharmacy information that meets National Council for Prescription Drug Programs’ standards.

Further certification should be sought from the Drug Enforcement Administration’s electronic prescriptions for controlled substances rule, which designates that the medication management technology has been subject to an audit process.

A Case In Point

One senior care organization leveraging health information technology tools to improve medication management and reduce PIMs is a nonprofit, faith-based organization with two continuing care retirement communities in Northern Virginia. The company offers a continuum of services and health care, as well as home, palliative, and hospice care.

One of the company’s buildings recently completed a medication-management pilot project that integrated and consolidated its EHR and e-prescribing data across the enterprise. The pilot project was part of its program to create a more homelike environment, including easier access to the outdoors or shorter distance to basic activities, but also clinical changes to help reduce PIMs while still effectively managing residents’ conditions.

While residents’ preferences about their medications and side effects are a major consideration, so are analyzing clinical data and working with residents’ physicians and  pharmacies to identify unnecessary prescriptions. The results have been a significant reduction of PIMs and improved communication with residents’ physicians about prescribing behaviors.

Quality Improvement Is Continuous

Whether it is improved medication management or another quality target, with data easily accessed across an organization, clinical leaders can efficiently monitor trends and clinical documentation from any location. This access makes facility or community reviews more efficient because leadership is better informed prior to visits. More review time can be spent understanding and improving team workflows instead of determining which data are accurate.

In addition, demonstrating quality improvement trends to prospective residents, families, payers, or provider organization partners is easier and more accurate and timely than trying to report from disparate clinical data analytics systems. Easily integrated and interoperable information systems also make participating in emerging value-based care models, such as Accountable Care Organizations, much more feasible and cost-effective for senior care companies.

Not to mention, top-down-driven quality improvement initiatives, especially when they involve altering physician behaviors, are less likely to be successful without input and collaboration from frontline clinicians and other caregivers.

By involving all providers in goal setting, listening to their feedback, and understanding their concerns, organizations can gain better insight into how the leadership’s quality-improvement targets will impact clinician workflows and, most importantly, resident care.

With the internal and external providers’ collaborative participation in quality improvement goals, organizations can increase the likelihood of achieving the desired safety results and clinical outcomes.

These goals may include reduced PIMs and adverse drug events, which will no doubt also improve staff morale, resident care, and community-wide satisfaction.
Aric Agmon is executive vice president and president of MatrixCare CCRC Solutions.