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Title: Identification of Medications and Confounding Risk Factors Associated with Hospital Admission within Island Health Home and Community Care (HCC) Population

Rationale:

  • In an effort to maximize patient safety and improve outcomes, the HCC Quality Council has tasked the medication safety-working group within HCC to develop an approach to identify the clients most likely to benefit from a comprehensive medication reconciliation thereby decreasing the number of clients who require this service. Therefore the working group is focusing on determining the medications and confounding factors most highly implicated in these cases. The outcome of this initiative is to improve the quality and efficacy of the Med Rec assessments. HCC data will be utilized to identify elderly patients at high risk of hospitalization following referral to HCC. The working group is seeking an approach to evaluate clients’ risk of medication misadventure. To achieve this, clear criteria for a medication risk assessment for Vancouver Island HCC clients is required.

Clinical Question:

In elderly patients referred to Island Health Home and Community Care (HCC), which factors predict early ER admission? The factors reviewed will include the use of one or more of the identified high-risk medications, number of medications, prior hospitalization and delegation of task.

Study design:

  • Retrospective chart review in conjunction with Home an Community Care.
  • The outcomes will identify patients most likely to benefit from MedRec following HCC referral may be identified and targeted quickly for assessment by HCC clinicians. This has the potential to decrease subsequent hospitalizations, related morbidity, mortality and healthcare costs. Medication risk assessment strategies to determine patients most likely to benefit are recommended by Accreditation Canada, ROP 2015.

Primary Outcome      

1) Proportion of clients prescribed one or more high-risk medication prior to ER hospital admission within 90 days of HCC referral              

                                                                                                                                                                                                                                                                                                                           Secondary Outcomes

1) Incidence of individual high-risk medication classes resulting in ER hospital admission within 90 days following HCC referral

2) Average number of medications prescribed in the study and control population

3) Clients with delegation of task in place prior to ER hospital admission and

4) Risk of ER hospital admission in clients with a previous hospital admissions 30 days prior to HCC referral.

Primary Project Advisor/Preceptor/Investigator/Co-investigators

  • Donna Goring, HCC pharmacist
  • Holly Sulsbury, HCC pharmacist
  • Dr. Donna Buna, Pharm D

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