Evidence supports periodic labs for patients on certain medications. Nonadherence to these rules may have health consequences that could harm patients, especially frail older adults that reside in an Assisted Living Facility (ALF). Most residents at ALFs see doctors in the communities and use different pharmacies which makes it very difficult to universally track their medical records. This was especially difficult in the time of the COVID-19 pandemic restrictions at the facilities with an inability to organize safe and on time blood draws, on site or in the community. This resulted in many gaps of care for the health of frail older adults.
All patients in an ALF who are receiving certain medications should have recommended labs monitored as per FDA medication labeling. This is done to detect and react to drug toxicity to avoid any unwanted medication side effects that may have life threatening outcomes if left unaddressed.
Quality Improvement Methods
Medication lists and laboratory results were reviewed from patients’ medical records and administrative data at a 58-bed assisted living facility. For each patient receiving ACEI/ARBs, diuretics, SSRIs, warfarin therapy, digoxin therapy or thyroid supplementation labs were reviewed to see if drug monitoring recommendations were satisfied. If lacking, effort was done to check if patient's physician visit or labs were planned or upcoming for that patient. To all recognized providers, a general letter containing the recommendations for Labs Monitoring for Common Medications (Pharmacist’s Letter, Document 260704) was sent. A plan to send more concrete pharmacy recommendations to delinquent providers was in place as an additional step.
Initially, before implementing this Quality Improvement Project, almost 60% of reviewed records had gaps in monitoring of recommended labs for unwanted side effects of different medication’s classes. This period did overlap the time of restrictions with the COVID-19 pandemic. Since starting this ongoing QIP and start of close collaboration of all providers, almost 90% of the residents had physician’s office or on-site visits and blood work orders to satisfy these recommendations. On initial review, labs were lacking in 26% of charts receiving ACE/ARBs medications and SSRIs. TSH results were lacking in 15% of patients on thyroid supplementation, to reach 100% after intervention. PT/INR were always done with full compliance (100%) and monitored through the analyzed period.
To provide on time, quality care for older adults at the ALF, there is a clear need for all involved health care providers to collaborate closely despite the divergence and non-universal teams involving parties from many different systems (different physician providers, pharmacies and laboratories). Individual education on all levels of professional care including but is not limited to RNs, MDs, PharmDs, facilitated by the Administrators and Medical Directors is mandatory for success.
All authors have stated there are no financial disclosures to be made that are pertinent to this abstract.
© 2022 Published by Elsevier Inc.