Geriatric Polypharmacy Initiative:

Improving Geriatric Outcomes

E3 | The Goldilocks Paradox: Too Many, Too Few…Getting Medications Just Right

Heather Shivas and Colleen Inglis

Disclosure Slide

Nothing to disclose

No financial competing interest

No conflicts to declare

Source of Income

St. Joseph’s General Hospital, Comox Valley

Clinical Practice Background

Acute general medicine

Residential care

Community practice

What was the aim of our initiative?

Initially

Optimize outcomes by reducing polypharmacy

Additionally

Enhance clinical pharmacy involvement in medication

decision making

Change physician prescribing patterns

Improve patient flow

Context

St. Joseph’s General Hospital

Area Number of Beds

Long Term Care 125 in 2013 and 115 in 2015

Acute Care 120

Transitional Care 22 of the 120 Acute Care Beds

What assumptions did we make?

Patients taking numerous inappropriate medications

Strong evidence results in medication changes

Nursing would engage and provide patient follow up

Physicians accept clinical pharmacy recommendations

How did our assumptions work out?

Most patients taking five or more inappropriate

medications

Barriers to nursing practice changes

Limited geriatric evidence problematic for

physicians to accept all clinical pharmacist

recommendations

Single biggest change that has taken

place?

Culture change improved outcomes:

Increased clinical pharmacist presence

Interdisciplinary clinical pharmacy referrals

Nursing staff engagement

Collaborating with physicians

Our single most

significant lesson learned?

What we need help with?

Triaging high risk patients

Timeliness of clinical pharmacist consults

Limited clinical pharmacist follow up

Nursing staff push back

Questions for you?

Contact Information

St. Joseph’s General Hospital Pharmacy

250-890-3025

Heather Shivas

Email: heather.shivas@viha.ca

Colleen Inglis

Email: colleen.inglis@viha.ca

Residential Care Outcome Measures

Time Frame # Patients on more

than 5 medications

# Patients on more than

9 medications

Aug 1-Oct 31

2013

83% 52%

Aug 1-Oct 31

2014

63% 23%

Aug 1- Oct 31

2015

66% 19%

Antipsychotic Use at the Views

Date Overall Antipsychotic Use at the Views

Sept 2013 41%

Sept 2014 38%

Sept 2015 35% 23% regularly scheduled 29% used only as needed

Acute Care Outcome measures

Time Frame # Admissions prevented

# Pharmacy Recommendations Accepted

Medication Reduction

June 2014 to Sept 2015

41 91% 66 - 83% 5-6 meds