1. Medication Management in Assisted Living Lessons from Current Research

2. 85% of assisted living residents require assistance with medications NCAL

3. NSRCF First time national assisted living data collection effort by the CDC/NCHS/ASPE www.cdc.gov

4. NCAL Assisted Living State Regulatory Review 2012 – www.ncal.org

5. CEAL Nonprofit collaborative of 11 national organizations: Alzheimer’s Association, AALNA, AAHSA, AARP, ASHA, ALFA, CCAL, NCAL, NCB Capital Impact, PVA, Pioneer Network

6. Background Research Challenges Recommendations

7. Older adults take an average of 5 prescription medications per month CEAL

8. Those with 3+ chronic health conditions Average 6-7 prescription medications per month CEAL

9. Assisted Living Residents 10 routine medications per day 3 PRN medications per day

10. state regulations are all over the map

11. 10 states utilize nurse delegation

12. 20 states allow unlicensed assistive personnel to administer medications

13. 20 states require “assistance with self- administration”

14. “assisting with self-administration” a regulatory play on words

15. Background Research Challenges Recommendations

16. Observational Study: Oregon Health and Sciences Institute, Rutgers, University of Washington, and Northern Illinois University

17. 28.2% medication error rate in assisted living

18. 70.8% of medication errors in AL are related to dose timing

19. 8.2% error rate when “time” errors are removed

21. No errors were judged highly likely to cause harm (out of 1373 errors)

22. CEAL/UNC Research:

23. 35% of medication administrations involved an error

24. 71% of errors were again related to dose timing

25. < 3% of errors had moderate to significant potential for harm

26. Med Techs did NOT have a higher error rate than nurses

27. Written test results “predicted” likelihood of errors

28. Background Research Challenges Recommendations

29. Challenges: Large volume of routine medications

30. Challenges: PRN Medications

31. Challenges: Injections

32. Challenges: Healthcare providers who do not specialize in geriatrics

33. Background Research Challenges Recommendations

34. Focus on high-risk medications

35. 1/3 of emergency room visits by older adults presenting with ADE are caused by 3 drugs: Warfarin Insulin Digoxin

36. CEAL/UNC Research Showed majority of errors with potential for harm related to: Warfarin Insulin Risperidone

37. Warfarin Monitor for s/s of bleeding Coordinate lab tests Monitor OTC use

38. Insulin Follow delegation procedures Monitor residents who self- administer

39. System Redesign Consistency in medication management regulations across states

40. System Redesign Improve training of unlicensed assistive personnel

41. System Redesign Streamline documentation, perhaps through use of electronic health records

42. Individualized Medication Plans Promote person-centered care in all aspects of resident care

43. Individualized Medication Plans Tailor medication schedule and use of PRN medications

44. Individualized Medication Plans Based on resident decision-making capacity, needs, and lifestyle choices

45. Josh Allen, RN Care and Compliance Group jallen@careandcompliance.com