Medication Management Across the Continuum

By Leslie Leite

medmang1The assignment in the medical management breakout session Wednesday seemed straightforward: Review information on a patient's medications, create a Medication Action Plan to identify any potential issues and place the patient's daily medications in a pill organizer divided into days of the week.

No problem for an audience filled with nurses, physicians, pharmacists and other clinicians, right?

The reality was somewhat different, but the big payoff was in a deeper understanding (and appreciation) of the medication management challenges faced every day by healthcare providers across the Kindred continuum and the opportunity to brainstorm on how to better address those challenges.

medmang2The session was led by James Poullard, Derek Szesny and Mark Lehman, all Kindred employees in pharmacy-related roles, and Justin Kullgren, an associate professor in the Department of Pharmacy Practice at South College in Knoxville, Tennessee, and a speaker at the 2015 Clinical Impact Symposium. The leaders outlined the assignment, which dealt with Mary and Jack Marton , an older couple dealing with various medical issues and, most recently, coping with Jack's surgery after a fall caused him to break his hip.

In this session's scenario, Jack has returned home after a stay at an Inpatient Rehabilitation Facility (IRF), and his wife, Mary, is struggling with the numerous medications, both over-the-counter and prescription, that Jack is supposed to take.

medmang3The session attendees were broken into small groups of five or six. Each group was given a list of the medications Jack was taking prior to the surgery (provided by Jack and Mary), a list of the medications given to the couple after he left the IRF and the medication reconciliation list. They also were given 10 different vials of over-the-counter and prescription drugs and a pill organizer. Each group was to function as an interdisciplinary team of home health caregivers with the goal of identifying potential issues on the Medical Action Plan and filling the organizer with the right pills for each day. To up the ante, this visit was on a Saturday and Jack needed to start taking the medications the next day.

The session leaders roamed the room, answering questions, giving advice and, above all, listening to the various approaches used by the numerous groups and to the varied challenges they faced in completing the task.

medmang4Despite the wealth of clinical knowledge and experience in the room, even these groups struggled with sorting through the bottles and the various lists of drugs. They found that some medications prescribed when Jack left the IRF weren't on hand, while others that were no longer needed were still in the home. There were questions about why this drug had been prescribed or was this other one even necessary based on Jack's current condition.

While some groups tackled each of the tasks together, others used the divide-and-conquer approach. What emerged was that both could be successful. How a team functions best can be based on the individuals involved and the skills or expertise they bring to the table. The exercise also illustrated that two different decisions about the same medication could be right.

medmang5At some point in the session, all of the leaders noted that medication management isn't just black and white. They also emphasized the importance of reaching out directly to the pharmacist and highlighted the pharmacy resources available to all Kindred clinicians.

Each year the Kindred Clinical Impact Symposium focuses on a topic to enhance clinical practice in the post-acute continuum and to maintain Kindred as a leader in clinical excellence. This seventh symposium focuses on effective care management and, specifically, fall prevention and medication management across the continuum. At this week's symposium, held in Louisville, Kentucky, national speakers discuss these topics broadly, while internal speakers bring it home to Kindred attendees from across the country.