Medication Management and M2020

Transcription

1 Medication Management and M2020

2 Oasis & Home Health Compare

3 Home Health Compare Quality Measures Process Measures Timely initiation of care Flu Vaccine received for current flu season Pneumonia vaccine received Diabetic foot care/education implemented Depression assessment conducted Drug education provided on all meds Multifactor fall risk assessment completed Outcome Measures Improvement in ambulation Improvement in bed transfers Improvement in pain interfering with activity Improvement in bathing Improvement in management of oral meds Improvement in dyspnea Improvement in surgical wound status Acute care hospitalization ER use without hospitalization Rehospitalization within 30 days of SOC

4 (M2020) Management of Oral Medications: the patient's current ability to prepare and take all oral medications reliably and safely, including administration of the correct dosage at the appropriate times/intervals. 0- Able to independently take the correct oral medication(s) and proper dosage(s) at the correct times 1- Able to take medication(s) at the correct time if: (a) individual dosages are prepared in advance by another person OR (b) another person develops a drug diary or chart 2- Able to take medication(s) at the correct time if given reminders by another person at the appropriate times. 3- Unable to take medications unless administered by another person 4- NA No oral medications prescribed.

5 Response-Specific Instructions Completed at SOC, ROC, and Agency Discharge. Refers to ALL oral medications (does not consider sub-lingual, buccal, swish and expectorate, or meds administered per gastrostomy). Includes assessment of ability to obtain meds from where they are stored, read the label or otherwise ID the med, open the container, and select the correct number/dose of medication. If the patient sets up their own medi-planner and is able to take correct medication dosages and correct times, Response 0 is appropriate.

6 Response-Specific Instructions Response 1 is appropriate if patient is independent with a mediplanner filled by someone else or by themselves with assist, or if another person must modify the storage container for improved access (removing child proof lids, marking labels for improved identification). Response 2 is appropriate if daily reminders are needed, regardless if patient is independent or needs assist with preparing doses. Reminders provided by a device the patient can independently manage (i.e. alarmed medi-planners) are not considered assistance or reminders. Response 3 is appropriate if physical/cognitive ability on day of assessment does not support daily safety and success OR if it has not been established yet that set up, a drug diary, or reminders can be successful. Patients residing in ALFs are NOT necessarily a 3.

7 Drug diaries and Med planners

8 Matching colors on medi-planner to colors on the chart aids in ID of time of day. It is recommended that each time of day meds are taken be in a different color (versus color coding based on day of the week).

9 Instructions **Fill your pill box at the same time every week** MED BOX FILL TIME: 1. Take all bottles out of the boxes and line them up in the order they appear on the chart. 2. Starting with the first pill in line, fill each pill across the entire row- use the chart to tell you what color row and how many go in each box. 3. Once you fill a medication across the whole row, put the bottle BACK IN THE BOX. Check behind yourself after each medication to ensure nothing was missed. Check the bottle to see if you have enough for NEXT week. Set the bottle aside if a refill is needed. 4. Call in all refills as soon as you are done!

10 Modifications *Count out 7 (14 for meds taken 2x/day) FIRST, then fill across the row. This will help with accuracy. *Get the green bowl out of the cabinet to count meds into. *Check the bottle to see if you have 7 pills left for NEXT week. Tell Karen if you need any refills. *Once you fill a pill across the whole row, put the bottle aside WHETHER AM OR PM. All bottles go back in the lock box.

11 Allen Levels

12 Allen Level Low 5 Memory aids and planning aids such as medi-planners, calendars, auto-bill pay options and alarms can be useful. Some level of supervision and or assistance is needed to adhere to a routine/establish a chart. Medi-planner is recommended starting at Level 5.4.

13 It is ideal to develop a medication system by Level Low 5, as new learning is possible and ability to assess cause and effect is still present, as well as use of trial and error.

14 Allen Level High 4 New learning can be established with repetition and consistency, but individuals may have difficulty adapting to new routines. Typical to start to see a lack of insight. Rigid routines are recommended for success, as familiar tasks can be independently sequenced but not modified well by the individual.

15 Individuals may be resistant to changing their current medication management at this stage, but with repetition and consistency, new habits and procedures can be developed. Will need to educate caregivers on how to tell when patient is declining and how to access therapy services again if needed by contacting the MD.

16 Allen Level Low 4 Training in new routine sequences can be helpful but carryover can not be expected. Individuals may be able to determine when there is a problem but have difficulty executing a solution. Use of memory aids is likely to be disorganized Individuals can/may manage 3-4 step sequences once learned

17 Medi-planners can still be successful to assist with managing, but supervision and assist will definitely be needed. If individuals have a systematic method for managing a mediplanner or drug chart established at level High 4 or above, these tasks can remain in procedural memory in this stage.

18 Allen Level High 3 Individuals require direct supervision and assistance. Some levels of independence can be maintained by allowing patient to complete parts of the task such as counting out pills, opening bottles if able, reading the label, or putting pills in boxes. Charts are arranged simply and designed to be easy to read and follow, so caregivers can easily be trained in med management when the time comes.

19 The Right Number of Visits at the Right Time

20 Utilization Must be aware of HHRG scores and recommended number of visits. Frequency/Duration for med management can require an increased quantity of visits due to nature of the process but we still have to work within OASIS guidelines. Consider the urgency/need for med management. It may be indicated before other therapies OR may be better placed straddling 2 certification periods after other disciplines have discharged and it can be the only focus.

21 Takeaways

22 The earlier you establish a systematic, simplified approach the better. Each patient has different strengths and weaknesses with the process. These need to be carefully assessed and incorporated into chart development. Chart systems can also be used by caregivers/family to assist with accuracy of med planner fill when/if it needs to be taken over. Educate caregivers on how to assess for changes/decline and make sure they know how to re-initiate therapy services if needed.

23 Ready Set Go!