Redevelopment of Child & Adolescent Mental Redevelopment of Child & Adolescent Mental Health Health

Medication Teaching Sheets – Dean Elbe, Medication Teaching Sheets – Dean Elbe, PharmD, BCPPPharmD, BCPP

The problemThe problem

• Other than ADHD, virtually Other than ADHD, virtually nonenone of common of common meds used in CAMH are Health Canada meds used in CAMH are Health Canada approvedapproved

• No official manufacturer patient information No official manufacturer patient information addressing this population; use is ‘off-label’addressing this population; use is ‘off-label’

• Manufacturer produced materials limited to Manufacturer produced materials limited to approved uses/age groups onlyapproved uses/age groups only

• Recent Recent **HUGE****HUGE** fines to US Big Pharma fines to US Big Pharma for off-label/pediatric promotionfor off-label/pediatric promotion

Old Format – BCCH 2006Old Format – BCCH 2006

Med Teaching Sheets 2006Med Teaching Sheets 2006

Positives:Positives:• Sheets address the pediatric Sheets address the pediatric

populationpopulation• Available online (BCCH website)Available online (BCCH website)• 3-4 pages, .pdf format documents3-4 pages, .pdf format documents• White space, good layoutWhite space, good layout• Answers 10 ‘stock’ medication Answers 10 ‘stock’ medication

questionsquestions• Pharmacist createdPharmacist created

Med Teaching Sheets 2006Med Teaching Sheets 2006

Negatives:Negatives:• Hard to find on BCCH site – multiple clicksHard to find on BCCH site – multiple clicks• Risk/benefit info not enough for informed Risk/benefit info not enough for informed

consentconsent• Difficult update & review process – Difficult update & review process –

via BCCH Education departmentvia BCCH Education department• Limited access to update sheets on BCCH Limited access to update sheets on BCCH

websitewebsite• Lacking language consistencyLacking language consistency• ADHD treatments document 14 pages long!ADHD treatments document 14 pages long!• English language (only)English language (only)

Factors at PlayFactors at Play

• Newly funded Kelty Mental Health Newly funded Kelty Mental Health Resource Centre/websiteResource Centre/website

Kelty Mental Health websiteKelty Mental Health website

Factors at PlayFactors at Play

• Newly funded Kelty Mental Health Newly funded Kelty Mental Health Resource Centre/websiteResource Centre/website

• CAMH becoming more independent CAMH becoming more independent from BCCHfrom BCCH

• Recent controversies in child psychiatry Recent controversies in child psychiatry (suicidality & SSRIs, metabolic effects (suicidality & SSRIs, metabolic effects of SGAs)of SGAs)

• New dedicated clinical pharmacist (me!)New dedicated clinical pharmacist (me!)

• Increasing demand for medication Increasing demand for medication information in alternate languagesinformation in alternate languages

OpportunitiesOpportunities

• Move ownership to Kelty CentreMove ownership to Kelty Centre

• No longer dependent on BCCH No longer dependent on BCCH process,process,able to effect change more quicklyable to effect change more quickly

• Funding available for translation Funding available for translation servicesservices

• Involve multidisciplinary team in Involve multidisciplinary team in redesign of the teaching sheetsredesign of the teaching sheets

The CommitteeThe Committee

• Clinical Pharmacist ledClinical Pharmacist led

• 2 Pharmacy Students (Directed 2 Pharmacy Students (Directed Studies)Studies)

• 3 Child & Adolescent Psychiatrists3 Child & Adolescent Psychiatrists

• Nursing EducatorNursing Educator

• Kelty Mental Health Centre ManagerKelty Mental Health Centre Manager

• Parent-in-ResidenceParent-in-Residence

• Youth-in-ResidenceYouth-in-Residence

The PlanThe Plan

• Reviewed current teaching sheet Reviewed current teaching sheet format format and other available versionsand other available versions

• (eg. Dulcan, ‘1 pager’, Sick Kids (eg. Dulcan, ‘1 pager’, Sick Kids formats)formats)

• Seek input from Health Literacy Seek input from Health Literacy SpecialistSpecialist

Other FormatsOther Formats

DulcanDulcan ‘‘1-pager’1-pager’Sick KidsSick Kids

The PlanThe Plan

• Tweak overall formatting, add info on Tweak overall formatting, add info on evidence of benefits, directly address evidence of benefits, directly address medication risks medication risks

• Split ADHD sheet into individual Split ADHD sheet into individual medicationsmedications

• Create teaching sheets for newly Create teaching sheets for newly released medsreleased meds

• Standardize language, phrasing, Standardize language, phrasing, formatting for consistency, and to formatting for consistency, and to reduce translation costsreduce translation costs

The PlanThe Plan

• Pharmacy students revise teaching Pharmacy students revise teaching sheets; Initial review by clinical sheets; Initial review by clinical pharmacistpharmacist

• Sent to all committee members for Sent to all committee members for feedbackfeedback

• Clinical pharmacist finalizes sheets and Clinical pharmacist finalizes sheets and standardizes language/formattingstandardizes language/formatting

• Post sheets to Kelty Mental Health Post sheets to Kelty Mental Health websitewebsite

• Arrange translation to other languagesArrange translation to other languages

SSRI teaching sheet - EnglishSSRI teaching sheet - English

TranslationTranslation

• by Provincial Language Service (PLS)by Provincial Language Service (PLS)

• Consistent, accredited, sustainableConsistent, accredited, sustainable

• Most common language requests in BC Most common language requests in BC and and our programs: Mandarin (simplified our programs: Mandarin (simplified chinese), chinese), Cantonese (traditional chinese), PunjabiCantonese (traditional chinese), Punjabi

• Cost: Cost: $0.41/word$0.41/word (for each language) (for each language) plus bilingual review & revision chargesplus bilingual review & revision charges

• Each document: ~2000 words (x 40 Each document: ~2000 words (x 40 sheets)sheets)

Provincial Language ServiceProvincial Language Service

Translation by the NumbersTranslation by the Numbers

• SSRI sheet: 2,031 wordsSSRI sheet: 2,031 words

• At $0.41/word: $832.71 At $0.41/word: $832.71

• Bilingual review: $130Bilingual review: $130Post-review revision: Post-review revision: $97.50$97.50

• Save 12% – no HST (we are both in Save 12% – no HST (we are both in PHSA)PHSA)

• Total cost: $1060Total cost: $1060

PER LANGUAGE !!PER LANGUAGE !!

• x3 = $3180 per sheet (Punjabi, SC, TC)x3 = $3180 per sheet (Punjabi, SC, TC)

SSRI teaching sheet - PunjabiSSRI teaching sheet - Punjabi

SSRI teaching sheet – Simplified SSRI teaching sheet – Simplified ChineseChinese

SSRI teaching sheet – Traditional SSRI teaching sheet – Traditional ChineseChinese

Translation by the NumbersTranslation by the Numbers

• PLS: Only pay once to translate a phrasePLS: Only pay once to translate a phrase• Risperidone sheet: 1970 words, but…Risperidone sheet: 1970 words, but…

‘new’ phrases not already done: ‘new’ phrases not already done: 800800 wordswords

• At $0.41/word: $328At $0.41/word: $328• Bilingual review: $130Bilingual review: $130

Post-review revision: Post-review revision: $97.50$97.50• Total: $555.50Total: $555.50

• Cost of ‘full’ translation: $1035.20Cost of ‘full’ translation: $1035.20• Savings:Savings: $479.70/language x3 = $479.70/language x3 = $1439.10$1439.10

Translation by the NumbersTranslation by the Numbers

BUT WAIT !!BUT WAIT !!

Translation by the NumbersTranslation by the Numbers

• Aripiprazole sheet: 1836 words, but…Aripiprazole sheet: 1836 words, but…‘new’ phrases not already done: ‘new’ phrases not already done: 284284 wordswords

• At $0.41/word: $116.44At $0.41/word: $116.44

• Bilingual review: $130Bilingual review: $130Post-review revision: Post-review revision: $97.50$97.50

• Total: $343.94Total: $343.94

• Cost of ‘full’ translation: $980.26Cost of ‘full’ translation: $980.26

• Savings:Savings: $636.32/language x3 = $636.32/language x3 = $1908.96$1908.96

TranslationTranslation

• Careful pre-planning and Careful pre-planning and standardizationstandardization

• Large portions of teaching sheets within Large portions of teaching sheets within a drug class had similar/same phrasinga drug class had similar/same phrasing

• Identical phrases identified to PLS; Identical phrases identified to PLS; no charge for these phrases (no charge for these phrases (cut n’ cut n’ pastepaste))

• Preplanning = MAJOR Preplanning = MAJOR $$AVINGAVING$$ !! !!

• 10 sheets available in 4 languages by 10 sheets available in 4 languages by AprilApril

SSRI sheet – translation markupSSRI sheet – translation markup

SSRI teaching sheet – Simplified SSRI teaching sheet – Simplified ChineseChinese

risperidone sheet – translation risperidone sheet – translation markupmarkup

Monitoring FormsMonitoring Forms

• Request from AACAP to use our Request from AACAP to use our antidepressant and antipsychotic antidepressant and antipsychotic monitoring forms in their members monitoring forms in their members toolkit toolkit

Antipsychotic Monitoring FormAntipsychotic Monitoring Form

EvaluationEvaluation

Satisfaction surveySatisfaction survey

• Did you/your child start taking a new Did you/your child start taking a new medication during your admission?  medication during your admission? 

• If yes, did you receive/download a If yes, did you receive/download a Medication Information Sheet ?Medication Information Sheet ?

• WasWas this information helpful for this information helpful for learning about how to give/take the learning about how to give/take the medication? medication?

• Was this information helpful for Was this information helpful for learning about medication benefits and learning about medication benefits and side effects? side effects?

Leading Practice SubmissionLeading Practice Submission

• Submit survey data to Submit survey data to Accreditation Canada for Leading Accreditation Canada for Leading Practice designationPractice designation

Kelty Mental Health websiteKelty Mental Health website

Oh,Oh,and and there’s there’s oneonemore more thing...thing...

À venir (Coming Soon) À venir (Coming Soon)

• Ontario CFE in Child & Youth Mental Ontario CFE in Child & Youth Mental HealthHealth

• In exchange for permission to post In exchange for permission to post teaching sheet content on their teaching sheet content on their website;website;

• They will translate all 40 sheets into They will translate all 40 sheets into French; French;

• At zero cost to BCMHAS;At zero cost to BCMHAS;

• Estimated savings:Estimated savings:

$31,40$31,4000

Redevelopment of Child & Redevelopment of Child & Adolescent Mental Health Adolescent Mental Health

Medication Teaching SheetsMedication Teaching Sheets

Dean Elbe, PharmD, BCPPDean Elbe, PharmD, BCPPClinical Pharmacy SpecialistClinical Pharmacy Specialist

Child & Adolescent Mental Health Child & Adolescent Mental Health ProgramProgram

BC Mental Health & Addiction ServicesBC Mental Health & Addiction ServicesVancouver, BCVancouver, BC

delbe@cw.bc.cadelbe@cw.bc.ca

Other Formats - DulcanOther Formats - Dulcan

Other Formats – Sick KidsOther Formats – Sick Kids

Other Formats – ‘1-pager’Other Formats – ‘1-pager’

Repeated PhrasesRepeated Phrases

You may wish to share this information withYou may wish to share this information withyour family members to help them toyour family members to help them tounderstand your treatment options.understand your treatment options.

Since every person's needs are different,Since every person's needs are different,it is important that you follow the adviceit is important that you follow the advice

provided to you by your own doctor, nurseprovided to you by your own doctor, nurseand/or pharmacist and speak to them if youand/or pharmacist and speak to them if youhave any questions about this medication.have any questions about this medication.

phrase appears in 38 of 40 sheetsphrase appears in 38 of 40 sheets

Redevelopment of Child & Redevelopment of Child & Adolescent Mental Health Adolescent Mental Health

Medication Teaching SheetsMedication Teaching Sheets

QUESTIONS ??QUESTIONS ??

Dean Elbe, PharmD, BCPPDean Elbe, PharmD, BCPPdelbe@cw.bc.cadelbe@cw.bc.ca