Aljoya Master s Scholar Janis Miller

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1 Aljoya Master s Scholar Janis Miller

2 Identification of Clinician and Staff Roles Related to Medication Management and Safety in Assisted Living Facilities in Two States Illinois and New Jersey Janis Miller Aljoya Master s Research Scholarship School of Nursing University of Washington

3 Acknowledgements: Funding Aljoya Master s Research Scholarship detornyay Center for Healthy Aging WA and OR: National Institute of Nursing Research, R21 NR NJ: Robert Wood Johnson Foundation, Assistant Secretary for Planning and Evaluation, DHHS IL: Sarah S. Fuller Memorial Scholarship, NIU School of Nursing; Illinois Department of Healthcare and Family. Services, Medicaid Advisory Committee, Long-Term Care Subcommittee State Primary Investigators: Dr. Donna Munroe, Illinois Dr. Susan Reinhard, New Jersey Dr. Suzanne Sikma, Washington Dr. Heather Young, Oregon

4 Why Medication Management is important in Assisted Living Facilities (ALFs) : Medication management identified by General Accounting Office as one of the top 3 quality issues in ALF settings. 36,400 ALFs serve >900,000 US residents Provides fluid health care & meets medication needs of residents Medication use in ALFs 3.8 to 6.2 routine daily meds reported in literature 9.6 routine daily meds in this WA-OR-NJ sample 50% - 75% of ALF residents receive medication assistance

5 Research Aim & Significance Aim: to analyze data from multiple staff perspectives and identify how assisted living roles, structures and processes influence medication management and safety. Significance: qualitative data provides a deeper understanding of the responsibilities and contributions of the roles of those involved with medication management in Assisted Living Facilities (ALF) insights for subsequent intervention research to advance safe, quality medication management practice

6 Methods: Qualitative sub-analysis of 2-state (Illinois and New Jersey) data-set from larger 4-state parent study using grounded theory approaches Data generated from semi-structured, openended individual interviews by parent study team with Nurses (RN and LPN) Unlicensed Assistive Personnel (UAPs ) Registered Pharmacists (RPh) Administrators Sample/research participants: Illinois: 2 Nurses; 2 UAP; 3 Administrators; 1 Pharmacist; 1 Resident from 3 ALFs New Jersey: 7 UAP; 6 Nurses; 4 Administrators from 4 ALF communities

7 Role Perceptions Nurse Role - Illinois Nursing role is complex and involves multitasking and linking multiple parties & systems. Direct medication administration and oversight Quality Safety / errors and follow up, tracking UAP oversight - reactive Monitoring of needs/ health status of residents, communicating information Nurse Role - New Jersey Medication oversight, UAP state regulated delegation Quality Safety / errors and follow-up, tracking UAP oversight, medication delegation, teaching & ongoing monitoring of UAP medication responsibilities Monitoring needs/ health status of residents, communicating information

8 Role Perceptions UAP Role Illinois Medication assistance, reminders and follow-up Report resident changes and new information State regulations expand medication UAP Role New Jersey management role & responsibilities of UAP Medication reviews and administration as per state regulated delegation instructions, assistance, reminders, follow-up Quality discovering and reporting med errors Report resident changes, new information, monitor for med changes and side effects

9 Role Perceptions: Pharmacist Role - Illinois Medication fills new, refill and urgent Quality checks Medication Administration Records (MARs), errors Communication State regs in New Jersey increase pharmacist s involvement in medication management Pharmacist Role New Jersey Medication fills new, refill and urgent Quality checks MARs, errors Communication Quarterly consultation (state regulated)

10 Conclusions & Implications: The nursing role in ALF medication management is multifaceted and complex A strong nursing leadership role is critical to quality State regulations impact scope of roles Nursing role is crucial and unevenly enacted Strong, reliable communication systems essential

11 Conclusions & Implications (cont d): UAP role success requires consistent training, ongoing communication, and clear expectations Multiple demands on UAP time increase risk of error Reliable medication management depends on trust in the competency of the UAP Increased pharmacist involvement improves safety and reduces potential for harm

12 Insights and Learnings: Nursing Research: Qualitative research is intense A struggle to set aside assumptions and beliefs Have to stay focused when immersed in the data An iterative process - between hunches & evidence Pace the analysis exhausting take breaks Aging: Elders are human too! Even the best intended regulations, procedures and rules do not make up for human kindness, attention and compassion Finding the balance between the need for control over one s life and being safe often requires letting go of independence and accepting assistance from others The Roles: Relationships, trust and humanity are critical in managing medications, meeting health needs & promoting quality of life

13 THANK YOU! For the support of a scholarship that will contribute to the quality of life of an aging population.