Reducing Medication Administration Frequency in Veteran Community Living Centers.

BACKGROUND: A quality improvement initiative of the Veterans Health Administration (VHA) aims to reduce frequency of medication administration to Veterans per day. Medication administration practices in our community living center (CLC) units are similar to an acute care medical unit versus a home environment. The objective of this project was to reduce medication administration frequency in order to minimize the number of interruptions to both Veterans and nurses. METHODS: A retrospective chart review was conducted for Veterans residing in a pilot CLC from January through March 2018. Electronic medical records and barcode medication administration (BCMA) logs were assessed. Data collected included demographic information and medication details (eg, drug name, frequency, administration time). Data were analyzed and pharmacist recommendations were documented into an Excel document, and then discussed with the pilot CLC unit medical provider in March 2018. The primary outcomes measured were the number and type of pharmacist recommendations, percent reduction in the average number of Veteran interruptions per day, and percent reduction in the average number of medication passes by nurse per day. RESULTS: Thirty-one Veterans were identified with a range of 4 to 31 active prescription orders. Fifty-five pharmacist recommendations were made and 31 were implemented. The average number of Veteran interruptions per day was reduced by 13.9%. The average daily number of medication passes was reduced by 16.3%. CONCLUSION: Both Veteran interruptions and nurse workload decreased due to the implemented pharmacist recommendations. Pharmacists will continue medication consolidation on a monthly basis and spread this project to other CLC units.

Pharmacist-Driven Step-Down of Long-Term Proton-Pump Inhibitor Therapy.

OBJECTIVE: To evaluate the appropriateness of proton-pump inhibitor (PPI) prescribing and reduce the number of outpatients on long-term PPI therapy, defined as greater than or equal to one year.
DESIGN: Phase I was retrospective and evaluated the appropriateness of PPI prescribing. Phase II was prospective and involved implementation of a pharmacist-driven PPI step-down protocol.
SETTING: This study was conducted in an outpatient setting at Veterans Affairs Hudson Valley Health Care System.
PATIENTS, PARTICIPANTS: Patients were limited to a single primary care provider and were required to fill an outpatient PPI prescription between August 15, 2015, and August 15, 2016.
INTERVENTIONS: After patients were identified in Phase I as having an inappropriate indication for long-term PPI therapy, they were contacted by a pharmacist to complete the step-down protocol. The patients then received a call two weeks after completing each step.
MAIN OUTCOME MEASURE(S): To determine the number of patients without an indication for long-term PPI therapy that could successfully complete the PPI step-down protocol.
RESULTS: Phase I identified that long-term PPI therapy was not indicated in 68.4% of patients. Phase II implementation demonstrated that 71.4% of patients were able to successfully step-down from PPI therapy in an average of 13 weeks with the use of alternative acid-suppression therapy.
CONCLUSION: This study concluded that a majority of PPI prescriptions were not indicated for a duration of greater than or equal to 1 year. With the implementation of a pharmacist-driven PPI step-down protocol, a majority of patients were able to tolerate the PPI step-down with the use of alternative acidsuppression therapy.