Target Audience

Nursing facility medical directors, consultant pharmacists, administrators, directors of nurses.

Purpose

Nursing facility administrators and directors of nurses have often identified the professional disconnection between physicians and pharmacists in effective reduction efforts of the off label use of antipsychotic drugs to control behaviors for residents with dementia and other drugs such as anti-anxiety agents, hypnotics, and anti-depressants. Nursing facilities are under significant regulatory pressure to reduce or eliminate the use of these drugs whenever it is medically feasible. 

Changes in the physicians and medical extenders who staff hospital emergency rooms and take call for physician practices seems to have resulted in more nursing facility residents making trips to the ER or being admitted for observation which often leads to health care acquired conditions such as increased pressure ulcers, falls with injuries, weight loss, infections, or increased use of antipsychotics. CMS funded initiatives such as INTERACT (Interventions to Reduce Acute Care Transfers) have been introduced to facilities to improve assessment of conditions and the communication of changes in resident condition to physicians. For initiatives such as these to be successful, nursing facilities must have physicians who understand how INTERACT or other such initiatives are serving as quality improvement projects in nursing facilities. 

This one-of-a-kind retreat will focus on bringing medical professionals and facility leadership together to discuss ways to improve the quality of care for nursing facility residents. In today's rapidly changing healthcare environment, increased collaboration and communication is vitally important for medical professionals and nursing facility providers. 

Agenda

Learning Objectives

Care Deliver Challenges and Newer Payment Models in Post-Acute and Long Term Care

• Outline the factors making the current fee for service model untenable for the future
• Compare and contrast proposed future methods of facility and physician reimbursement
• Understand the strengths and weaknesses of such plans for improving patient care outcomes when applied to the long term care and post-acute care settings
• Understand the data reporting requirements which will drive value based purchasing models
• Understand the need for improved communication and consultation among providers and disciplines to achieve increased quality of care and reduced cost
• Create opportunities for facilities, physicians and pharmacists to develop plans for success under these new reimbursement plans which require

Effective Strategies to Reduce Avoidable Hospitalizations among Nursing Facility Residents 

• Understand the CMS Triple Aim and the market place emphasis on improving the quality of care for consumers and reducing the cost related to unnecessary hospitalizations
• Understand the risks and costs for patients related to unnecessary hospital stays
• Develop effective approaches to medical director leadership that helps multi-disciplinary teams of LTC pharmacy and nursing disciplines develop needed skills to minimize the risk of unnecessary hospitalizations
• Verbalize how physicians and other medical providers and pharmacists can work cohesively to prevent drug related events requiring hospitalization 
• Identify evidence based practices that have been successful in reducing re-hospitalizations or preventing unnecessary hospitalizations in the LTC and post-acute care arena

Palliative and Care and Hospice – Options for SNF Providers

• Distinguish the differences between hospice and palliative care options
• Understand the composition of the palliative care team and the consultation process
• Identify triggers that might be used in nursing facilities for a palliative care referral
• Validate the use of palliative care in the nursing facility setting
• Understand how resident and family choice may enhance quality of life and support palliative care treatment options 

Pain Management – One Key to Reducing Antipsychotic Use

• Understand the various neuropsychiatric symptoms associated with dementia and a stepwise approach to manage problem behaviors
• Identify pain management as a potentially unmet need in dementia residents with behavioral disturbances
• Recommend appropriate pain assessment strategies for residents with dementia
• Understand the clinical evidence for the use of analgesics as a strategy to reduce behavioral symptoms in residents with dementia
• Recommend appropriate analgesics when untreated pain is identified or suspected as an underlying contributor to behavioral disturbances related to dementia
• Adequately monitor the response to an analgesic when used to treat pain in patients with dementia and adjust or discontinue therapy as indicated

Successful Team Approaches to Antipsychotic Reduction and Appropriate Drug Use When Non-Pharmacologic Approaches Fail

• Evaluate causes of behavioral and psychiatric symptoms in dementia
• Describe the principle of non-drug management of behavioral and psychiatric symptoms of dementia
• Determine whether an antipsychotic drug Is appropriate for a person with dementia
• Select an optimal antipsychotic and dose for a person with dementia based on efficacy, side effects, and the person’s comorbidities
• Describe the multidisciplinary team approaches for managing behavioral and psychological symptoms of dementia in the nursing home setting, including optimal communication practices around antipsychotic use
• Discuss appropriate strategies for implementing gradual dose reductions of antipsychotics per regulatory requirement, and the evidence supporting them

Navigating the Difficult Path of Treating Patients with Dementia

• Know the most common causes of dementia
• Be able to differentiate the more common causes of dementia
• Understand the initial intervention for common behavioral complications of dementia
• Have increased awareness of the interdisciplinary team process needed for the successful management of long term care patients with dementia
• Identify communication strategies for working with patients, families and caregivers 

Reducing Hospitalizations by Preventing Adverse Drug Events

• Describe the pharmacokinetic and pharmacodynamics changes that occur with aging
• Discuss risk factors associated with adverse drug events in older adults
• Recognize medication categories that are associated with adverse drug events in older adults
• Develop strategies to minimize or prevent adverse drug events in older adults
• Apply learned strategies to this session in the role of a LTC consultant pharmacist as a member of the multidisciplinary team

Medical Directors’ Roundtable Discussion

• Discuss the medical director’s role in overall quality improvement strategies as a member of the facility’s quality improvement team
• Discuss the role of the medical director to influence best practices related to avoiding re-hospitalizations and unnecessary hospitalizations and the appropriate use of palliative and hospice care with the LTC multidisciplinary team and other physicians and medical providers in the facility
• Discuss the role of the medical director in influencing the appropriate use and monitoring of psychotropic drugs among nursing home residents
• Effectively engage with the LTC interdisciplinary team including the consultant pharmacist,  and other medical providers to improve medication use and reduce adverse drug events
• Identify effective strategies and best practices related to the delivery of long term care in the new payment environment 

Consultant Pharmacists’ Roundtable Discussion

• Discuss the consultant pharmacist’s role in overall quality improvement strategies as a member of the facility quality improvement team
• Discuss the pharmacist’s roles and opportunities in ensuring appropriate use and monitoring of psychotropic medications in nursing home residents
• Discuss barrier to ensuring appropriate medication use and strategies to overcome them
• Effectively engage with the LTC interdisciplinary team including the medical director,  and other medical providers to improve medication use and the documentation of target symptoms and outcomes
• Identify effective strategies and best practices related to the prevention of all adverse drug events 

Speakers

Robert Bender, MD
Broadlawns Medical Center

Ryan Carnahan, MS, PharmD
University of Iowa

Charles Crecelius, MD, PhD, CMD
Delmar Gardens Nursing Homes & Washington University School of Medicine

Randy McDonough, RPh
Towncrest Pharmacies

Paul Mulhausen, MD
Telligen

J. David Nordstrom, MD
UnityPoint Health

Justin Rash, PharmD
Martin Health Services

Jeffrey Reist, PharmD, BCPS
University of Iowa

Speaker Biographies

Relevant to the content of this educational activity, Dr. Crecelius discloses that he receives honorarium from PharMerica for participating as a speaker on antipsychotic reduction, and Dr. Mulhausen discloses that he is a paid employee of Telligen. The remaining speakers indiciated they have no conflicts of interest to disclose. 

Continuing Education Credit

• MD:  This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Iowa Medical Society (IMS) through the joint providership of Des Moines University (DMU) and the Iowa Health Care Association. DMU is accredited by IMS to provide continuing medical education for physicians. DMU designates this live activity for a maximum of 9.25 AMA PRA Category 1 Credit(s)™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.
• DO: Des Moines University is accredited by the American Osteopathic Association (AOA) and approves this live activity for a maximum of 9.0 AOA Category 2-A credit(s).
• Other: This live activity is designated for a maximum of 9.25 AMA PRA Category 1 Credit(s)™.

Disclosure: Everyone in a position to control the content of this educational activity will disclose to the CME provider and to attendees all relevant financial relationships with any commercial interest. They will also disclose if any pharmaceuticals or medical procedures and devices discussed are investigational or unapproved for use by the U.S. Food and Drug Administration. Determination of educational content for this program and the selection of speakers are responsibilities of the activity director. Firms providing financial support did not have input in these areas. The information provided at this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.