Designing a Medication Screening Tool for the Geriatric Day Hospital at the Queen Elizabeth II Health Sciences Centre, Capital Health

Abstract

The internship was completed at “The Geriatric Day Hospital (GDH) which is part of the centre for health care of the elderly at the QEII Health Sciences Centre, Halifax, Nova Scotia. The Day Hospital provides different types of services to help the elderly reach a higher level of function or maintain their present level so they can stay in their home”(Capital Health, 2009)(1). The internship was started May 1st, 2009 and finished August 27th, 2009. The main objective was to design a medication management module as a flag system and use it to address specific medication problems among elderly patients using criteria selected by GDH to address two common problem types: 1. Anticholinergic burden risk that is “The combined effect of multiple medications that block the effects of acetylcholine in the body. Acetylcholine is one of the key chemicals in nerve cells that carry information from one nerve cell to another. Nerve cells that communicate with acetylcholine, called cholinergic neurons, are important in the heart, sweat and saliva glands, eyes, bladder, stomach, intestines and the brain. Medications that block acetylcholine, called anticholinergic medications, may be strong or weak blockers. Anticholinergic burden comes from the combined effect of all of a patient’s medications together to block acetylcholine". (ASCP, 2009) 2. Use of potentially inappropriate drugs (The Beers Criteria). (Beers et al. 1991, Beers 1997, and Fick, et al. 2003) There is no designated pharmacist for the GDH therefore as a part of the medication management module, we had a second objective. This objective use to design a communication component (information flow) between the geriatric team and the pharmacist by improving the current workflow and the processes. Last year, the GDH launched a new management system to capture the patient’s clinical information. This information includes mental and physical status, symptoms, conditions, drugs, etc. There is a case manager that is not a clinician. Most of the time this case manger is responsible to enter this information into the system. The medication entries are not dynamic. Sometimes, medications are being entered manually (both generic/brand names) which might cause duplications and other drug-related problems and errors that may endanger the lives of elderly, leave them with poorly controlled symptoms, or at risk for falls, or any other drug-related side effects. Provision of pharmaceutical care by a pharmacist and use of a computer screening tool can help prevent falls, Anticholinergic burden, use of inappropriate drugs and other medication-related problems for the geriatrics population. During the internship project phase, we had a major issue in trying to apply the rules to a non-standardized drug database. Also, we had another issue related to the drug classification coding system. Discussing this issue with the project members, we decided to look for a standardized drug database. However, the problem was solved by using the Health Canada Drug Product Database (DPD) and utilizing the Anatomical Therapeutically Chemical (ATC) drug classification coding system that is controlled by the World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology. This classification is chosen to be the proper drug coding system for our medication screening tool. “In the Anatomical Therapeutically Chemical (ATC) classification system, the drugs are divided into different groups according to the organ or system on which they act and their chemical, pharmacological and therapeutically properties. The drugs are classified in groups at five different levels.” (WHO, 2009). 4 This internship was a most valuable learning experience that allowed the author to apply the knowledge obtained through the first year of the Health Informatics Master program. Also, it inspired the author to think in different ways and provided ideas for developing effective solutions for issues related to the medication management information. The medication screening tool gave the author the opportunity to apply project management skills and enable adoption of insights and experiences. Also, it provided the author with new thoughts and ideas for the future of medication management by using the lessons learned from this module. This report outlines how the medication management module was designed in different phases and the obstacles that were encountered and dealt with. The report provides an overview of the drug use management and policy research residency and the GDH. It then outlines the relationship between the internship and Health Informatics. Also, in this report the author will provide conclusions and recommendations to improve the data quality and the knowledge sharing in GDH.