Recommendations to Improve Medication Management in Long-term Care Homes The report released in November 2009 by the Task Force on Medication Management in Long-term Care contains important recommendations to improve the safety of residents in long-term care homes in Ontario . Medication management is a crucial issue because of the growing complexity of medication use in residents. The report notes that the number of prescriptions issued to long-term care home residents increased 55% from 2005 to 2009. Concerned Friends often hears from families about concerns related to medication issues in long-term care homes. The Report from the Task Force identified four priority areas for action: 1. Medication Incident Reporting a) A common definition of a medical incident is needed to ensure consistent reporting and follow-up. The definition used by the College of Nurses of Ontario - “any preventable event causing inappropriate medication use or client harm”- is recommended. b) All medication incidents should be reported . Staff in long-term care homes need to be educated about reporting incidents. They should be provided with resources for analyzing incidents and developing strategies to improve medical management systems. It is important to understand that one must learn from errors. The report also suggests encouraging residents to state their name and the drug name (if they are able ) to increase their awareness of what drugs they are on and what the drugs look like. Staff should respond to questions from residents about their medication. 2. Medication Reconciliation (Communication at Admission/Readmission) a) Continue the implementation of medication reconciliation for all residents entering into, returning to, or being discharged from a long-term care home. The Ministry of Health and Long-term Care (MOHLTC) should promote the creation of an efficient system that supports resident safety at these times of transition. All homes should consider the adoption of electronic medical management systems. Investment in good technology has the potential to enhance safety. b) The Task Force needs to consult further with relevant experts to determine what else is needed to enable long-term care homes to implement effective and practical medication reconciliations. c) The MOHLTC should work with appropriate stakeholders and experts to develop and deliver training for long-term care home staff, physicians, and pharmacists in creating the best possible medication history for each newly admitted resident – a critical step in the process. The report raises concerns about the practice of using dangerous abbreviations and other unacceptable methods of expressing doses . 3. High Alert Drugs a) High alert drugs are ones that have a heightened risk of causing significant patient harm when they are used in error. A strategy that defines, identifies, monitors and evaluates the use of these drugs in LTC homes is needed and should be integrated into the home's medication management system. b) An education and information campaign should be provided to increase awareness of drugs that should be used with caution in the elderly. Ways of integrating this information into homes' operations should be developed and disseminated. 4. Technology Support a) The report recommends that a team of medication safety experts be formed to recommend specific technologies and supports necessary in homes to assist in technology decisions for safe medication practices b) The sector should investigate additional technology solutions that have the potential to improve safeguards for ordering, dispensing, administering and monitoring the use of medications. Next Steps The Task Force emphasizes that continued investment in medical management systems in long-term care homes is needed to meet the growing complexity of medication use in the elderly. The Task Force proposes to continue for another year to provide the necessary oversight and continuity for the implementation of their recommendations which, if successful, will improve safety and optimize medication management in homes. An implementation plan with deliverables and timelines would be included. Concerned Friends agrees that this report is timely. As the report states, “With our aging population and the growing use of medications in long-term care, initiating systemic improvements in medication management is good planning and a sound investment”. |