The Portal of Geriatrics Online Education

Quality Improvement Model

Achieving Quality Improvement and ACGME Core Competency Training Through a Nursing Home Polypharmacy Intervention

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
999
Abstract: 

Polypharmacy is common in elderly nursing home patients and predisposes them to risk of potentially inappropriate medication uses, potential drug-drug interactions, and increased health care costs. This innovative model of an educational quality improvement intervention project addresses polypharmacy and inappropriate medication use among nursing home residents using standardized tools and fulfills the ACGME core competencies of Practice-based Learning and Improvement and Systems-based Practice for Geriatric Medicine trainees.The intervention consists of 6 phases: pre-intervention training session, identification of target population, data collection, identification of potentially inappropriate medications, identification of potential drug-drug interactions and contraindications, and implementation. The intervention requires approximately 5 hours for 5-7 fellows and faculty geriatricians for 70-80 nursing home residents with polypharmacy. We found that the intervention worked best when incorporated into protected didactic "workgroup" sessions.This intervention increases medication safety, reduces medication costs and provides practical experience and education on polypharmacy and inappropriate medication use to Geriatric Medicine trainees and nursing home community physicians.

Educational objectives: 
  1. To fulfill ACGME core competencies of Practice-based Learning and Improvement and Systems-based Practice for Geriatric Medicine fellows.
  2. To provide practical education on polypharmacy and inappropriate medication uses among nursing home residents to Geriatric Medicine fellows and nursing home community physicians.
  3. To provide practical experience in a nursing home quality improvement project.
Additional information/Special implementation requirements or guidelines: 

The tools used in this intervention are the Beers Criteria to identify potentially inappropriate medications and the Epocrates online drug-drug interaction program to identify potential drug-drug interactions and contraindications. These tools can be replaced by more updated or relevant tools according to settings or target populations to optimize the intervention effects.

We recommend using the updated Beers Criteria: freely available on the American Geriatrics Society Website: http://www.americangeriatrics.org/health_care_prof...

We found that the implementation of this quality improvement project was most successful when there was a dedicated faculty geriatrician overseeing the project. We designated "workgroup" times on the didactic schedule for the Geriatric Medicine trainees to review the selected patients' charts to complete the data collection form. The faculty geriatrician and the trainees discussed the potential recommendations for each patient as a group, which was also very helpful and provided an additional method of teaching. We also found it very helpful to have the nursing home consultant pharmacist and nursing home director of nursing assist in identifying the nursing home patients with polypharmacy and providing input about the impact of the project on the nursing home staff. We had very positive feedback from both the consultant pharmacist and director of nursing about this project.

Publications from, presentations from, and/or citations to this product: 

Publications:

Tamura BK, Bell C, Lubimir K, Iwasaki W, Ziegler L, Masaki K. Physician Intervention for Medication Reduction in a Nursing Home: The Polypharmacy Outcomes Project. J Am Med Dir Assoc. 2011; 12(5):326-30.

Kojima G, Bell C, Tamura BK, Inaba M, Lubimir K, Blanchette PL, Iwasaki W, Masaki K. Reducing Cost by Reducing Polypharmacy: The Polypharmacy Outcomes Project. J Am Med Dir Assoc.2012 Sep 4. [Epub ahead of print]

Presentations:

Lorenzo P, Bell C, Iwasaki W, Masaki K, Blanchette P. Polypharmacy Improvement Adherence Project: Nursing Home Medication Cost Outcomes. Poster presentation at American Geriatrics Society Meeting, Chicago, May 2009, (role: Co-mentor, co-author of Fellow Pia Lorenzo). Abstract in J Am Geriatr Soc 2009; 57(1, suppl): S147-148.

Lubimir K, Ziegler L, Bell C, Masaki K, Iwasaki W, Blanchette P. "Cost-Effectiveness of Reducing Polypharmacy in a Nursing Home: The Polypharmacy Outcomes Project." Poster Presentation, American Geriatrics Society Meeting, Washington, D.C., May 2008 (role: Co-mentor, co-author of Fellow Karen Lubimir). Abstract in J Am Geriatr Soc 2008; 56(1, suppl): S50-51.

Ziegler L, Lubimir K, Bell C, Masaki K, Iwasaki W, Blanchette P. “Medication Reduction in a Teaching Nursing Home: The Polypharmacy Outcomes Project.” Poster Presentation, American Geriatrics Society Meeting, Washington, D.C., May 2008, (role: Co-mentor, co-author of Fellow Laura Ziegler). Abstract in J Am Geriatr Soc 2008; 56(1, suppl): S49-50.

Date posted: 
Fri, 06/07/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 06/07/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , and . Achieving Quality Improvement and ACGME Core Competency Training Through a Nursing Home Polypharmacy Intervention. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/892
Subscribe to RSS - Quality Improvement Model