Abstract
Objective
As part of the Missouri Quality Initiative (MOQI) to reduce hospitalizations for long-stay
nursing home residents, this article describes reasons MOQI advanced practice registered
nurses (APRNs) recommended medication order changes as part of their medication review
process as well as the outcomes of their recommendations.
Design
Cross-sectional descriptive study of MOQI APRN-conducted medication reviews.
Setting
Long-stay nursing homes participating in the MOQI project.
Participants
Seventeen MOQI APRNs recorded medication reviews for 3314 long-stay residents residing
in 16 Midwestern nursing homes over a 2-year period.
Intervention
APRNs conducted medication reviews and made recommendations for medication order changes
to residents' medical providers.
Measurements
The MOQI medication review database was used to abstract data.
Results
There were 19,629 medication reviews recorded for 3314 residents during the 2-year
period. Of the 19,629 reviews, 50% (n = 9841) resulted in recommended order changes
of which 82% (n = 8037) of order changes occurred. More than two-thirds of recommendations
were because of changes in the residents' plans of care. Other recommendations included
adjusting and/or discontinuing medications that had the potential for harm.
Conclusion
Resident care needs are dynamic, resulting in the need for frequent medication order
changes. MOQI APRNs, because of their advanced pharmacological education and daily
presence in the nursing home, are uniquely positioned to ensure residents' medications
aligned with their overall goals of care while minimizing risk of harm.
Keywords
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Article info
Publication history
Published online: November 28, 2017
Footnotes
The authors declare no conflicts of interest.
This project was funded by grant number 1E1CMS331080 from the Centers for Medicare and Medicaid (CMS) Innovations Center and Medicare-Medicaid Coordination Office (http://innovation.cms.gov/initiatives/rahnfr/), which is focused on improving care and outcomes for Medicare-Medicaid enrollees residing in nursing facilities. The content is solely the responsibility of the authors and does not necessarily represent the official views of CMS.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
