Case Study: Reducing HRM in the Elderly
REDUCING HIGH-RISK MEDICATIONS IN THE ELDERLY
Beaver Health Mart Pharmacy, Brighton Health Mart Pharmacy and Beaver Falls Health Mart Pharmacy are family-owned pharmacies located in Beaver, New Brighton, and Beaver Falls, Pennsylvania, respectively. These pharmacies range in age from less than 2 years old to a recent anniversary of 25 years old. While each store harbors its own niche service (immunizations, compounding lab, long-term care services), the daily focus is on traditional retail customer health. By implementing the high-risk medications (HRM) program in February 2014, these stores have enjoyed success in helping keep their patients safe.
Challenge
As they had done with successfully reducing ACE-ARB gaps in care for diabetes treatment, Beaver Health Mart and Beaver Falls Health Mart pharmacies wanted to improve their quality measures scores for HRM in the elderly. They realized that preventing the fill is key and that the team needed to identify HRM in patients over 65 before they were dispensed or refilled.
Solutions
- Educated and trained pharmacy team on list of high-risk medications and viable alternative treatment options
- Incorporated HRM identification into all drug utilization and chart reviews
- Identified HRM items in pharmacy-management system by character tag in item description
- Used standardized physician fax template to identify potential gaps in care to physicians
- Implementation of medication synchronization efforts afforded the time to perform the interventions
Results: At or Above 5-Star Goals for Four Out of Five Measures
- At or above 5-star goal on four out of five measures
- Focused on ACE/ARB and in one year, reached top 20% of performers across all retail stores
- Intangible results emerged as prescribers began to ask for recommendations and assistance in their own practices to avoid HRMs
- They also learned that success is not static; the performance scores slide if the program is not maintained. This is not a "one and done" effort. They saw their scores drop when they lost focus.
- Their expectations are to emerge from the red by the end of summer. They are hopeful that their September scores will show not only progress, but achievement.
Snapshot of Beaver Pharmacy's EQuIPP dashboard from May 2014 showing their performance at or above 5 star goals for four out of five measures.
HOW TO SUCCEED LIKE BEAVER HEALTH MART AND BEAVER FALLS HEALTH MART
If you're interested in implementing a high-risk medication program, here are some suggested steps:
❑ Educate the team
- Educate the pharmacy team on list of high-risk medications in the elderly
- Identify alternative therapy recommendations to offer prescribers when requesting a therapy intervention
- Identify HRM items in pharmacy-management system by color or alphanumeric tag in the item description for on-the-fly intervention targeting
- Keep fax request template handy for staff to act immediately upon realization of intervention opportunity
❑ Post the high-risk medications list in the pharmacy for easy reference
- HRM list is available on the Health Mart Operations Manual
❑ Involve the whole pharmacy team and ask for their assistance in recruiting patients
DISCLAIMER: This case study is for informational purposes only. The results of this case study depend on a variety of factors that are unique to this organization. There is no guarantee that your results will be similar to this case study. Each party's results will depend on the factors of its business. The success in this case study cannot be used as an indication of future success with these programs.