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Innovative new medication review process improves lives of chronically ill patients

By Alanna McNaught
Winnipeg Regional Health Authority
Published Tuesday, June 22, 2021

Innovation in health care isn't limited to new cures and technologies. Often, it occurs with the simple realization, "We can do better."

Such was the case with an award-winning new medication review process developed by the pharmacy team at Winnipeg's Deer Lodge Centre.

Deer Lodge Centre is home to about 100 chronically ill patients whose health-care needs are too complex for home care or facilities such as assisting living or personal care homes, and who are ill-suited for care in hospital acute care units designed to diagnose, treat and return patients to the community as quickly as possible.

These patients - ranging in age from 20 to 90 - have complex medical issues including tracheostomies, enteral (tube) and parenteral (IV) nutrition, ostomy care, complex wound care, neurological disorders such as amyotrophic lateral sclerosis (Lou Gehrig’s disease), muscular dystrophy, multiple sclerosis, and Parkinson's Disease, post traumatic brain injuries, brittle (hard-to-control) diabetes and dialysis, among others.

Not surprisingly, their medication needs are often equally complex, and go far beyond those of the typical patient or resident in care. The pharmacy team at Deer Lodge Centre worked with physicians, nurses and other health-care professionals to review those needs, but felt that patients and staff alike would benefit from a more structured process.

In 2019, Dr. Nancy Dixon - currently Regional Lead, Medical Services & Chief Medical Officer for the Winnipeg Regional Health Authority, but at that time, serving as an attending physician on one of Deer Lodge Centre's three chronic care units (and as the facility's Chief Medical Officer) - presented the pharmacy team with an exhaustive, six-page medication review form used in Saskatchewan.

Given differences in how the health-care system operates here in Manitoba, the pharmacy team at Deer Lodge Centre went to work on creating a streamlined version that was easier to integrate into day-to-day use, and which incorporated feedback from physicians, nurses, and patients.

Though the COVID-19 pandemic slowed implementation of the new process to some degree, it found use in Deer Lodge Centre's chronic care wards throughout 2020, with its success earning the pharmacy team the Innovative Practice Award from the Canadian Society of Hospital Pharmacists' Manitoba Branch. 

Understanding why a new form is worthy of such recognition requires taking a closer look at the people it serves: chronically ill patients who, given their complex, long-term medication needs, call Deer Lodge Centre home.

I've long believed that the chronically ill are an underserved population throughout the Canadian health-care system. In a way, they are the square pegs that don't fit well into the health-care system's round holes.

Often, they have had a difficult time accessing the level of care they require, largely because each of them is an exception to the rule. That is to say, they require ongoing levels of care that go beyond what facilities such as personal care homes or hospital medicine units are designed to provide. Their conditions are far too acute for the former, and not acute enough for the latter, placing them between the proverbial rock and a hard place.

Unlike, say, cancer or dialysis patients, their treatment and medication needs are often varied. The only thing they have in common, in fact, is the chronic and often progressive nature of their conditions. Their medication needs are significant, and often fluctuate over time, and that's what makes an effective medication review process so important.

The new process - which mandates medication reviews every three to six months (or more often, as determined by the prescriber) - offers a formalized framework for investigating the many medication-related questions associated with caring for the chronically ill. Have there been behavioral changes since the last medication review? Mental health issues?  Have any new medical issues been diagnosed? Are the patient's medications still required? Are they age appropriate? Do they negatively interact with other medications? Can they be administered via the patient's feeding tube, or must they be administered by other means? The list of such considerations is lengthy, and requires input from the patient's care team, as well as the patient themselves, and their families.

Having a proven, formal process for medication review makes a real difference in the quality of life of patients living with a chronic illness that prevents them from living at home. It puts their needs first and, perhaps most importantly, demonstrates that even though their needs require more effort from their health-care team, they remain our top priority.

Providing that kind of peace of mind, and that kind of innovation, is something in which the entire pharmacy team at Deer Lodge Centre - and indeed, all Manitobans, can take pride. More than that, it's simply good form.

Alanna McNaught is the Medication Safety Pharmacist with the Winnipeg Regional Health Authority's Regional Pharmacy Program.

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