Shared Care Committee Polypharmacy Initiative
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Shared Care Committee Polypharmacy Initiative Dr. Keith White “Awesome” Physician Lead, SCC Polypharmacy Initiative Clinical Lead, Medication Reconciliation BCPSQC
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On January 18, 2013, the BC Patient Safety & Quality Council invited key stakeholders from across the province to join together in a day of meaningful discussion around: 1. The meaning of dignity in care, with a special focus on more appropriate use of antipsychotics; 2. The current state of antipsychotic use by people living in residential care in BC; 3. An overview of work currently underway throughout BC, nationally and internationally to identify opportunities for alignment as well as learning from others; 4. Envisioning an ideal state whereby more appropriate use of antipsychotic medications can be achieved; and 5. Framing a call to action that will ask teams from residential care facilities in BC to join our initiative. This is a presentation from the event delivered by Keith White, who is the BCPSQC’s Clinical Lead for Medication. Learn more about this initiative at http://www.bcpsqc.ca
Transcript of Shared Care Committee Polypharmacy Initiative
Shared Care Committee Polypharmacy Initiative
Dr. Keith White“Awesome” Physician Lead, SCC Polypharmacy Initiative
Clinical Lead, Medication Reconciliation BCPSQC
What is Polypharmacy?
Too many inappropriate medications?
Too many appropriate medications?
More than 5 medications?
More than 10 medications?
Our Definition
When the theoretical benefits of multiple
medications are outweighed by the negative
effect of the sheer number of
medications, regardless of class of medication or
“appropriateness” thereof.
Polypharmacy is a stand-
alone risk factor for
morbidity
Polypharmacy: What We Know
Average number of meds in RC = 9
Affects Quality of Life & Resident Safety
Decreases in:• Global Health• Cognitive Function
Increases in:• ADE’s• Risk of Falls
Adverse Drug Events
Lead to increased transfers to acute care• 5 or more 10%• 7 or more 20%• 9 or more 30%
Increase in transfers to acute care
Hospitalization-Associated Disability
Hospitalization is a sentinel event that often precipitates disability. This results in the subsequent
inability to live independently and complete basic activities of daily living (ADLs).
This hospitalization-associated disability occurs in approximately 1/3 of patients >70 years of age and
may be triggered even when the illness that necessitated the hospitalization is successfully
treated.
Polypharmacy itself should be conceptually perceived as “a disease,”
with potentially more serious complications than those of the
diseases these different drugs have been prescribed for.
Discharge Summary
Admission Dx: DeliriumDischarge Diagnosis: Urosepsis
PMH:1) Alzheimer’s2) COPD3) IHD4) Hypertension5) Diabetes6) Remote CVA
And No Mention of…
1) POLYPHARMACY
2) HOSPITALIZATION-ASSOCIATED DISABILITY
MedReviews
When we do MedReviews…
… we still look at the appropriateness of each individual med in the context of the Resident and fail to address the inappropriateness of the actual Number of Meds in the context of the Resident’s Dignity and Quality of Life.
Chemoprevention
Does not alter the All Cause Mortality!
Summary
Count the Pills!
