Medication Reconciliation Helps Optimize Homecare

The aging population wants to make the golden years golden. Seniors want the freedom of living at home, financial stability, social interaction—and most importantly, the independence to age in place.

According to the American Society of Consultant Pharmacists, seniors represent 14.5 percent of the population, consume 40 percent of all prescription drugs and purchase 35 percent of all over-the-counter drugs. Seniors also take an average of 14 prescriptions per year and are involved in 36 percent of all adverse drug events. Roughly 15 to 25 percent of senior drug use is considered unnecessary.

One-third of those aging in place have a potential medication problem, or are taking drugs considered inappropriate for seniors, according to the National Center for Biotechnology Information (NCBI). Elderly home health patients are especially at risk for adverse effects from medication errors. They often take multiple medications for a variety of issues that are typically prescribed by more than one provider. The majority of home health care patients routinely take more than five prescription drugs, and all too often, drift dangerously away from the doctor-prescribed medication.

Medication errors are more likely to occur in home health than any other health care setting. The unstructured environment and challenging communication needs in the home health system can lead to hospitalization.

Unplanned Hospital Admissions

Unplanned admissions are never a desirable outcome for any homecare patient, caregiver, family member or doctor. However, it happens frequently and can lead to problems long after discharge. Patients 65 years or older accounted for 31 percent of acute hospital admissions and 45 percent of hospital expenditures for all adults.

These unplanned admissions can lead to further health complications, patient and family stress, higher costs and changes in medication regimen. The goal of any patient is to be discharged, return home and avoid subsequent hospitalizations. Unfortunately, patients are readmitted at alarming rates. The rates for rehospitalization remain substantial, with 13.3 percent of home health patients being hospitalized again within the first 30 days of being discharged.

Patients end up back in the hospital for several reasons. According to a report by the Robert Wood Johnson Foundation, high readmissions can be blamed on the quality of patient care, discharge planning, care coordination and the availability and effectiveness of local primary care. Many of these lapses happen when a patient leaves the hospital to return to homecare.

A study by the Archives of Internal Medicine reports the biggest culprit is a lapse in drug regimens, meaning residents are taking the wrong medications. Another study cited medication errors as a main reason for hospital readmissions—researchers found roughly 19 percent of discharged patients had adverse events occur shortly after leaving the hospital—two-thirds due to medication errors. The Centers for Medicare & Medicaid Services (CMS) estimates those readmission rates due to medication non-adherence create an economic impact that is estimated to cost taxpayers nearly $100 billion annually.

The issue of hospital readmissions and the astronomical cost has come under scrutiny in recent years. Hospitals have been put on notice by the Affordable Care Act to reduce the high volume of readmissions or face tough financial penalties. In order to avoid leaving money on the table, hospitals and the health care industry have been forced to address the medication adherence challenges driving up readmission rates.

Smooth Transitions

Numbers and facts are hard to ignore. If the top reason some residents return to the hospital is due to lack of medication adherence, how can we make sure the hand off from hospital to homecare is error proof, simple and secure? It is important to ensure that a trusted medication management plan follows every step that a resident takes from the hospital and into the homecare environment.

Medication Reconciliation

Medication reconciliation helps curb errors in medication administration and ensures that patient safety remains a priority. Reconciliation happens when a patient’s medication needs are compared to their medication history in order to prevent errors that can include everything from leaving out necessary medication, to duplications, overdosing or mixing medication that can have adverse effects.

Barriers to Reconciliation

Problems with medication reconciliation occur at alarming rates when patients transfer from the hospital into the homecare environment. There can be a number of different problems based on the lack of communication between the hospital, doctors, pharmacy, caregivers and patients when the transition occurs. When patients make the transition home, some of the necessary information in their medical history may not make the trip with them. This can lead to a lack of proper information about the medication the patient has received in the past, which can inhibit the caregiver’s ability to properly care for the patient.

Another barrier to medication reconciliation is the lack of knowledge the patient has about his or own medical condition. If the caregiver has to rely on the patient to provide information on the variety of medication being taken or what his or her needs are, it could create problems when the patient doesn’t exactly know his or her own medical history.

Electronic Health Records

Medication reconciliation is a start. However, it can create cumbersome paperwork that may be misplaced and increase workload for caregivers who need to focus on the care of a resident. What if there is a sudden change in medication? How is that communicated in a streamlined, simple and error proof way from the physician to the pharmacy to the caregiver? There is a growing call for the implementation of electronic medication administration record keeping, or eMAR. The system tracks every step electronically in the medication process to eliminate errors, streamline information, reduce unnecessary paperwork and create a safe and error-proof process of medication management.

eMAR is widely used in assisted living, senior housing and long-term care communities to manage medication usage for residents. Facilities are seeing the results and the technology continues to improve and ensure quality care.

ACCUflo is an eMAR system designed for use among long-term care pharmacies and assisted living, memory care, and skilled nursing communities.

The system tracks each step in the medication administration process. It simplifies caregivers’ duties and workflow, allowing them easy and safe access to residents’ medical records, medication, treatments and care tasks. The system supports barcode scanning of medication packages to confirm proper resident, drug, dosage, give time prior to administration and notify caregivers when medication or treatments are missed. ACCUflo tracks when the medication is accessed, by whom, how much is administered while reporting, in real time, back to the pharmacy for a streamlined approach that reduces manual paperwork while saving time and money.

One medication error is one too many. This can help optimize and error-proof the shared process that connects caregivers and pharmacists to doctors so that seniors receive excellent care.