Webinar Recording: Patient Safety is Everyone's Responsibility -  Comprehensive Medication Management in Hospice Care

In recognition of National Patient Safety Awareness Week, this expert-led panel discussion brings together leaders from CHAP, QAPIplus, and BetterRX to explore how hospice providers can enhance medication safety and reduce preventable harm in the home setting.

With patients facing increasingly complex medication regimens at end of life, ensuring safe, effective, and individualized medication management is more critical than ever. This webinar explores how to build a patient-centered safety culture rooted in trust, shared goals, and proactive risk mitigation.

Topics include:

• The role of interdisciplinary teams in continuous medication monitoring

• High-risk medications and deprescribing strategies

• Medication reconciliation and documentation best practices

• Error and near-miss reporting as a foundation for quality improvement

• The impact of age-friendly care and the 4Ms framework

• Tools and protocols to support staff and empower patients and caregivers

You’ll hear real-world insights and strategies from nurses, pharmacists, and compliance experts who bring decades of experience across hospice, home health, and post-acute care. Whether you’re a clinician, administrator, or quality leader, this discussion offers practical takeaways to help your team deliver safer, more effective care.

WEBINAR TRANSCRIPT

0:10
OK, well it is 10:00 Pacific Time.

0:13
So hello and welcome everyone.

0:16
We're really happy to bring you this content today.

0:19
Our topic is patient Safety is Everyone's responsibility, a comprehensive medication management in Hospice care.

0:26
This is a timely topic as this week is National Patient Safety Awareness Week.

0:30
National Patient Safety Awareness Week was initiated in 2002 and is now led by the Institute for Healthcare Improvement.

0:37
It's dedicated to improving healthcare safety and reducing preventable medical errors.

0:43
Since its inception, Patient Safety Awareness Week has grown into a globally recognized event, fostering a culture of safety in healthcare systems worldwide.

0:52
Thank you for joining our panel discussion about elevating patient safety in Hospice care.

0:57
This interactive panel discussion will explore patient centered approach to safety with the focus on medication management including high risk medications, preventable errors and robust data collection, analysis and documentation.

1:11
We will also discuss the significant impact of age friendly Care at home certification on patient safety, integrating standards that ensure care practices align with what matters most to the patient and how everyone must come together for the benefit of patient care for housekeeping.

1:29
Our session is being recorded.

1:31
It will be available to all of those of you present today and those that were registered but unable to attend after the webinar is concluded.

1:39
Additionally, we'll also post this on our YouTube channel for for you to share with anyone you'd like.

1:45
I'm Denise Stanford with Chap and I'll be your moderator today.

1:49
Now it's time to meet our panelists.

1:52
Also, please feel free to use the Q&A during our discussion to post your questions, and we'll address those at the end.

2:02
All right.

2:03
And with that, Jennifer, will you start us off?

2:08
You are muted, my friend.

2:12
I am.

2:12
Thanks, Denise.

2:15
Hi, I'm Jennifer Kennedy.

2:17
I am the Vice President for Quality, Standards and Compliance at CHAP and I have been a home based care nurse for at least 38 years of my 39 as a nurse mostly in the Hospice and palliative care space.

2:39
Thank you.

2:39
And my name is Bymane Kadanian.

2:41
I am the CEO of COPY Plus.

2:44
I'm a nurse by background.

2:46
I've been in post acute care for over 20 years now and it's a pleasure to be part of this webinar.

2:56
Good afternoon everybody.

2:57
My name is Lynn Klima.

2:58
I'm a nurse practitioner with an an adult certification focus and I've been in healthcare for over 40 years across all settings, acute care, primary home care and Hospice and palliative care.

3:12
And I am currently serving as a patient safety officer for Coffee Plus.

3:18
Yes, thank you.

3:19
And I am Rebecca Christensen, I'm the director of clinical services and pharmacist for Better RX and I've worked Hospice for over 20 years and also some long term care for about 5 years.

3:35
All right.

3:35
Well, thank you all for that.

3:36
We're excited to have your expertise added to this topic today.

3:40
So with lab, let's get started by asking each of you to give us an overview on what patient safety means to you.

3:48
Lynn, as the patient safety officer, why don't you go ahead and kick us off?

3:52
Sure, thank you.

3:54
Just like all of you probably, you know, my focus means that patient safety is that we're trying to ensure that every individual or every patient that we take care of has the highest level of care without any risks or harms, especially when we're caring for people in this vulnerable space in their in their healthcare journey.

4:12
And that has the setting.

4:14
We know that in community based care, our services are vital in supporting patients with their daily activities and with their advancements in, you know, how their complex, their chronic illnesses are.

4:26
It's really challenging for them in the home environment.

4:29
And so I think we're obligated and you know, to create a space for them that is safe and effective and compassionate in their final days of their journey.

4:38
I also like to think of the evidence.

4:41
One of the things I wanted to call out as we're talking today is just the national action plan to advance patient safety.

4:47
So a lot of the things that we're going to talk about today fall under the multifaceted challenges that, you know, our patients face.

4:56
And so under the this national action plan, really what they're challenging us all to do is have a collaborative, evidence based and systematic approach to creating those safer environments for all of our patients.

5:09
So that's all I have.

5:11
That's what it means to me.

5:12
All right.

5:13
Well, thank you, Jennifer.

5:15
Thanks Denise.

5:16
So what it means to me is that patient safety is part of the overall quality proposition.

5:24
So there are many things that we do in quality to ensure that our patients are safe, they have a quality experience, they're getting the education they need, etcetera.

5:39
Also, it is part of the compliance proposition as well and does fit into federal and state regulations that home based care providers need to follow.

5:52
I think from a accreditation organization perspective, we at CHAP are invested to ensure that not only are are accredited providers compliant and providing quality of care, but that that care is safe and promotes the health of the patient.

6:17
And if there are caregivers involved, such as Hospice as a unit of care, that it promotes the caregiver as well.

6:26
Thank you.

6:27
Rebecca, will you add to that from your point of view?

6:30
Definitely.

6:31
So as a pharmacist, I always look at that risk versus benefit and make sure that they're getting that great amount of benefit for medication without the risk.

6:43
But it's not only about that, it's also about looking at the changes in the body in patients as they become terminal and looking at making sure the doses are correct and not too high where we can throw somebody into an overdose situation and making sure that those doses really do align with what the patient needs for their safety.

7:14
Right.

7:14
Thank you.

7:14
Armani, would you take it?

7:18
Sure, thank you.

7:19
So when I think of patient safety, I think of a shared commitment and that it is not only about protecting patients, but also supporting healthcare providers in delivering care.

7:33
So it is a system wide issue, right, where every individual in the organization understands their role, their specific role in preventing harm.

7:43
So it's about creating an environment, open communication, transparency and continuous learning.

7:50
So it's these and these practices should be embedded in the daily operations of an organization.

7:57
That's great, thank you.

7:59
Well, now that we've done that overview, let's get a little bit more granular.

8:03
So let's start by talking about the initial engagement with the patient and family caregivers.

8:08
What elements of that initial assessment.

8:10
Are critical to ensure patient safety?

8:13
Jennifer, could you start us with that?

8:16
Yeah, absolutely.

8:18
I think there are many aspects of that initial assessment that weren't discussion.

8:27
You're looking when you're going into someone's home, first of all, you're a guest, right?

8:31
You're coming in, you're looking at all the potential and actual safety issues in that home and which does include medication safety as well.

8:43
And I've been to many, many homes where you ask the patient and their caregiver if there is any, you know, for all of the medicines.

8:53
And it comes in this giant shopping bag on the kitchen table.

8:58
And then you spend, you know, the next whatever amount of time sorting through and you're like, OK, codeine from 1977 and all of those items, you know, assessing what they have, what is unused, what is expired, what are duplicates such, you know, as as polypharmacy is all of those things.

9:21
And then looking at the environment is, is there a place to safely store medications and manage medications?

9:28
I've been to many homes and many maybe my colleagues have as well, where, you know, there's just a it, it's so cluttered.

9:37
There's just a pathway to walk through.

9:39
And there's no safe place in any of the house where you could say this is the designated medication area.

9:48
So you have to look at all of these things.

9:51
And I think once you, you get through all of that on an initial visit, remembering again that these medicines per the DEA are the possession of the patient, right?

10:05
So we can make suggestions about, hey, this coding from 1977 might be good to let it go and dispose of it, but we can't make them do anything.

10:16
We can only make suggestions for their safety and their well-being.

10:22
But again, it's not like when you're in a facility and you have control over the patient and the patient's safety and you know, some of their, some of the decision making is taken off the table when a patient is in a facility.

10:38
That's not the same case in home based care.

10:41
So looking at everything, particularly high risk medications, polypharmacy and drug disposal with that shared collaboration and decision making, I think is is really key.

10:56
Thank you.

10:57
Armani, do you want to add to this course?

11:00
And along the same lines, I think in that initial engagement, medication reconciliation is a crucial component and it must be done with not just listing of the medications, but it must be an active process that engages the patients and the caregivers.

11:21
So the goal is not only to document medications, but to critically evaluate their appropriateness, effectiveness, safety for the patient's current situation.

11:33
So a medication could have been safe, let's say prior recent hospitalization or surgery, but maybe now that the patient is back home after surgery, the nurse doing the medication reconciliation should really recognize safety risks.

11:50
For example, any anticoagulation that the medications or any medications that may increase bleeding thus could have been appropriate in the before the hospitalization, but maybe not anymore.

12:04
So it's very important to do the Med rec.

12:08
I always say look at the actual bottles, don't look at papers, don't look at hospitalization papers.

12:14
Make sure the actual bottle is there and that way you can ensure that there is an active, accurate medication reconciliation done.

12:24
That's not just transcription, right?

12:27
So as registered nurses go out and do this work, it's, you know, writing, copying from bottles that's, you know, that's a skill.

12:35
But where your our clinical knowledge comes into play is that active engagement with patient, with the patient's condition and the medication list to really think about does this medication list make sense for the patient for an initial care plan, Right.

12:54
Thank you, Rebecca.

12:58
As a pharmacist coming in, we can make a lot of recommendations about what to stop and what's important and and what they really need.

13:07
But we need to get that family and patient buy in.

13:11
And often when we're making recommendations, we get a lot of resistance, a lot of, well, you're just trying to make me die faster, or you're just trying to take away my medications, or the doctor said I need to take this the rest of my life.

13:27
And trying to get that connection with the patient and that communicate them to them in a way that gets them on board to the changes we want to make for our patients safety.

13:42
Like those anticoagulants where that risk of having a severe bleed is 3-4 times higher than that risk of having a stroke.

13:52
And really trying to gather those tools that we need to educate our the not only the patients, but the decision makers, those patients, people that have that decision responsibility.

14:12
And that can be very, very difficult.

14:14
And trying to assess where they are and how we need to approach those changes that we're making can be a make or break with having a good relationship and making those changes for the safety of our patients.

14:30
Yeah, for sure.

14:31
It's an uphill battle to start with, isn't it?

14:34
Lynn, would you like to add please?

14:36
Yes, I think that, you know, this is really that most critical point when we're meeting our patients and our families for the very first time and it establishes, it has gives us the opportunity to establish that relationship with them and a true partnership.

14:54
So as speakers before me have identified, you know, part of what we need to do here is establish and build that trust with them so that they're more open to sharing with us changes in their medication practices is be trusting in terms of the recommendations that might be made.

15:11
That initial engagement is so critical.

15:14
I think the other thing that's important here is that, you know, taking the time in this initial assessment to really understand how they're taking their medications.

15:23
What do they know about their medications?

15:26
How are, you know, a lot of our patients take things because we tell them to, but we don't really take the time to understand what they know about them, how they feel about them.

15:36
When you look at the literature around medication adherence, some of the barriers that exist are one, related to trust, that they don't really trust what they're being told in terms of their treatment plan, especially at this particular vulnerable time where we are helping them, you know, transition and then their understanding and then the social influences, right?

15:57
So the impact that, you know, whatever we hear on the news about pain management or medications used for pain management, what our family members tell us, those biases that might be out there in terms of, you know, pain management that might inhibit them in terms of being really fully honest with us or being willing to try an appropriate treatment plan.

16:19
And then of course, just some of the access and cost issues as well, right?

16:23
Like how are they bringing it all together?

16:25
So I think starting out right from the very beginning, it's important to assess their understanding, their knowledge and then build that relationship with them so that we can engage them fully and and help them understand the value and ongoing communication with us about any their of their needs and their changes that they they would like and desire in terms of their treatment plans.

16:47
Yeah, absolutely.

16:48
Lynn, you took the thoughts right out of my head.

16:51
As Rebecca was wrapping up, I was thinking to myself, this is just such a vital time in building trust with the patient.

16:57
And I think that plays right into our next question about goal setting.

17:00
So when it comes to goal setting, where do you all see the greatest opportunities for improvement today?

17:06
And, and Armani, I'm going to have you start us off on this question.

17:11
As a major part of goal setting.

17:13
I would say the impact would be the follow up encounters with the patient to make sure that medication management or medication checks are completed during every encounter that the patient has.

17:31
If we think about sometimes a medication order that goes out to a pharmacy versus the dosages the pharmacy may have available.

17:42
Being a quality nurse, I have seen multiple medication errors come through.

17:47
One that I can remember was a Coumadin patient who forever had taken Coumadin 1 milligram three times a day and they're they had a change in pharmacy when they came to the Hospice and their Coumadin changed to 3 milligrams one tab a day.

18:07
Now, when this patient was not actively educated that your dosage that you're so very used to has changed, the patient took the three milligram Tab 3 times a day, what ended up to be a major bleed in the core outcome for this patient.

18:24
So in in issues like that, it's I think by recognizing or not taking for granted what a patient may know or what habits they may have.

18:36
So to really check the medication bottles every single visit so that you make sure that that medication profile is accurate, that the dose, the available dose and the number of times, even though it all adds up to the same dose at the end of the day.

18:54
But it really matters how the patient takes it.

18:57
So I think that's a major goal to make sure that the patient clearly understands the treatment plan and how to take the medications appropriately.

19:07
A lot of opportunity there for sure.

19:09
Jennifer.

19:10
Yeah, 100% agree with you, Armini.

19:14
Also, you know, we have to remember that the plan of care is the patient's plan of care.

19:21
And when we're goal setting, we should be engaged in shared goal setting and then the goal set that are developed have to be realistic for that patient.

19:31
It can't be our pie in the sky what we want them to do.

19:35
It's there.

19:36
There will be poor adherence and we won't reach goals if we approach a plan of care in that respect.

19:44
So really collaboration and shared decision making are extremely important.

19:51
And what I've learned from age friendly care, particularly from our age friendly care at home standards of care, is that when we're looking at medications, they have to align with what matters to that patient as as one of those key M's of the four M's.

20:13
So.

20:15
The opportunity, I think a goal setting is if we know the what matters to that patient, then that can help guide us to figuring out what medications can be prescribed it well, not from a nursing standpoint, but from a physician standpoint, but collaboration in that respect that helps the patient keep their what matters in place.

20:46
If Missus Jones, who likes to take her dog out in the backyard and play with her dog a little bit or sit down and watch her dog play, and she wants to ambulate out there on her own without feeling woozy from a medication that that takes care of a particular symptom.

21:06
That we need to figure out what medication takes care of the symptom doesn't give her that side effect so that she can get out there and watch and play with her dog in the yard every day.

21:17
Absolutely, Lynn.

21:20
Well, I think that this is, you know, again building on that relationship that we've developed with the patient and their family from you know, our initial encounters with them.

21:29
I think that, you know, goal setting is really important.

21:33
And I think we've all kind of fallen into this trap of the goals that we set with our patients are from a drop down list in an electronic medical record.

21:42
And so when you really as a clinician, really thinking about what is an individualized plan of care look like and what are those those goals that are relevant to the patient and the family.

21:53
It's just like we said earlier, you know, just really trying to include them in that partnership and sitting down and asking them, you know, these are the recommendations.

22:02
How will this work, right?

22:04
We want to help build their confidence in being able to manage the medical treatment plan and the medication plan that that we have or that's recommended for them.

22:13
But if they're not going to take it or not be able to take it or adhere to it for whatever the reason is, we want to make sure that we're, you know, building that into our interventions and our goals so that they're documented, right?

22:25
So that they're clearly documented in that plan of care that they, you know, are based on what the patient and the family desires.

22:34
So when is best to take the medication, how to take that medication and that we put that in a place where all team members can see it so that the burden isn't on the patient or the family to have to repeat to us why they're taking something the way that they're taking it.

22:50
We tend to in our teams are sometimes very isolated in the way that we approach our care with our patients and don't always share the information in a, in a robust way that others on the team would be able to read it and articulate it and know what to do with it.

23:09
So we want to make sure that we're, you know, really individualizing those goals and, and stepping back and thinking, you know, do I have an opportunity here to do better, to add more to that, you know, drop down list so that other folks know that and encouraging the patients to be a part of that.

23:25
I think that builds that trust as well because you're listening to them, you're hearing what their barriers might be.

23:31
You're incorporating that into the plan of care and you're building that confidence.

23:35
And you're also, you want to also help them think about and anticipate what are some things that might trip you up in this plan?

23:42
What are some things that might get in your way so that you, you know, aren't going to be successful?

23:47
And then how do you reach us, right?

23:48
How do you reach me or relevant members on the team to be able to make adjustments so that we have that partnership?

23:55
We really want to instill that whether it's with the patient, patient and caregivers or just the caregivers as we're, you know, supporting them on this, on this journey.

24:05
Thank you, Rebecca.

24:08
As was said before, we really have to align our goals with the caregivers and the patients.

24:16
Often we have the tendency to have our own goals that we want to reach for the patients, but we need to pull back and try to find that balance and look what they think is important.

24:29
Maybe we think, oh, they've got cancer.

24:31
And so I want really want to focus on managing that pain and getting on top of that pain.

24:36
But that pain's not bothering them and that's not a goal.

24:39
They're more concerned about that nausea and vomiting or they're more concerned about the spread of that cancer.

24:45
So we need to address that rather than looking at where we want to direct their goals and making sure that not only do we align with them, but we can continually reassess, OK, now that we have your nausea and vomiting under control, where do we want to work next?

25:04
How are you feeling now?

25:06
What is your next goal and your next step?

25:09
And and take rather than trying to meet all goals at once, prioritize them and take them little by little.

25:16
So we're not overloading our patients because sometimes that overload can really, whether it's information or changes can be a detriment to our patients.

25:29
And then we lose again that trust that we have been trying to establish this whole time.

25:35
Yeah, continuing the conversation, right.

25:37
It doesn't just stop at the single goal setting.

25:41
I want to keep keep it on you, Rebecca, and talk a little bit more about medication reporting and reconciliation.

25:46
So when you're doing that initially with the patient and family caregivers, what do you see as the biggest opportunities for improvement within that area?

25:54
And I know that we've kind of touched on this a little bit, so we might kind of move a little bit quickly through this question.

26:01
We really need to make sure that any changes that we make are noted.

26:07
Yeah, because I see a huge problem when I see multiple orders for the same medication and I don't know which one's most recent.

26:18
I don't know what changes have been made, so I don't know where to go next.

26:22
And so just making sure that we keep up to date and on what is the most current dosage, what's the most current schedule for these medications, what and making sure that we discontinue those medications that have been changed.

26:38
And if we don't do that, it increases that risk of having a medication error or causing harm to our patients.

26:46
So making sure that those medication lists are completely up to date and simplified to the ones that they are taking is very important.

26:57
Thank you.

26:57
I want to give each of you just a quick opportunity to add into that as well.

27:02
So Arbony, I would add for organizations, I would urge organizations to not be afraid of reporting medication errors.

27:12
And I want to clarify that a medication error to be reportable does not have to cause harm.

27:19
So anytime there's a medication error of omission or wrong time, it's it's important to report, not to be afraid to report because then you're almost like collecting data from a a patient habit perspective.

27:36
Maybe today they missed their medication, blood pressure medication because their blood pressure was normal and they thought well, my blood pressure's OK, so I should not take my blood pressure medication.

27:47
So this is a habit that didn't 'cause them problem for that this time.

27:53
But should this be done on a different medication, it might cause heart.

27:57
So I really urge organizations to not be afraid of reporting everything that happens where the medications are not taken exactly as prescribed.

28:07
Thank you.

28:08
Those are great opportunities for training of patient and caregivers, aren't they, Jennifer?

28:14
I think patient engagement and communication are top things for me.

28:20
We are partners with patients when we are engaging with them to care for them, either to get them to a play a better place than they were when we first met them or in the case of Hospice, to move them to a comfortable death.

28:39
And that can't happen if you don't have engagement with the patient in the family, IE trust.

28:48
OK, so we have to explain why we're looking at their medications and why we're doing that every time and why they need to tell us when they called their their doctor on the side and didn't tell us, they asked for something and we see a new bottle and we come into the house that we've never seen before.

29:07
So strengthening that communication between the patient and the family and also other caregivers, the interdisciplinary team, multidisciplinary team is really critical for the reporting of oh, I made a mistake when I took this medicine or we made a mistake when we distributed the medication from maybe a pharmacy standpoint.

29:36
So those are those are my two cents on that one.

29:40
Thank you, Lynn.

29:42
I think in, in this space when you're thinking about, you know, having the most access to the most accurate medications, you know what we can't understate the the value of Med reconciliation, particularly around those transition points.

29:55
You know, anytime there's a transition and being able to encourage the patient and the family to have the confidence and the comfort level to be able to share those.

30:06
If there's any changes that are made with that, with their medications and anything new that's been prescribed.

30:12
The document presentation that we talked about already in terms of making sure that we can clearly see what's been, you know, discontinued or started.

30:19
And those those changes even with situational medications like antibiotics and why, why the person was placed on an antibiotic and why why was it discontinued or changed, that sometimes is problematic.

30:33
I think the other thing is that while we're delivering care in a space at end of life, knowing in, in some respects in that medical history of that patient, what were the medications that they were taking and why in that medical history?

30:49
Because sometimes it'll come back to haunt you.

30:51
Somebody like if you don't bring out that big brown bag and look at everything that's been there, someone will pull something off of the shelf because it worked before, right?

31:00
And so if you see it showing up, it might be something that they just, you know, dragged out of the back room somewhere because they wanted to try to help their family member think about inhalers and the number of different inhalers people can find around their house.

31:12
And, you know, they just kind of bring them back out again.

31:15
So we want to we want to be the bearer of all that information front and center in that medical record.

31:20
And then again, that seamless communication with them so that they when they're telling one of us or we're making those changes, they don't have to repeat that story over and over again.

31:30
And we are prepared.

31:31
We know what those changes have been and we can see that clearly documented in the record.

31:37
Yeah, that's a great point.

31:38
And I was just thinking not even just pharmaceutical, right, We're probably thinking of over the counter as well or herbal or those type of things that can also cause a lot of problems.

31:48
Home remedies.

31:50
Yeah.

31:50
Home remedies.

31:51
Yeah, exactly.

31:52
Yeah.

31:52
Thank you.

31:54
Well, moving on a little bit.

31:55
So after that initial engagement with the patient and we have that patient on care and now we need to consider the care planning, the intervention to ensure that patient safety.

32:06
So let's talk about some strategies to optimize medication management.

32:11
Rebecca, since this is, you know, your calling and your area, let's start with you.

32:16
I always look at the whole picture of a patient.

32:19
And often a lot of our patients and our caregivers, there's a lot of barriers to making sure that they're taking the right medication at the right time.

32:28
And we have a tendency to do lists or planners or words.

32:34
And when a lot of our patients have poor eyesight, whether it's with glaucoma or cataracts or macular degeneration, it's hard to see those words.

32:43
And so utilizing things like pictures of those meds and a time clock to show them, OK, you take this picture of this Med at this time I and making sure we put away things.

32:57
I remember once I had a patient that just saw syringe out of the corner of their eye and they thought, oh, I'm in pain.

33:03
I think it's my morphine.

33:04
Well, it turned out to be Heparin again.

33:08
Making sure things are put away so they're just not grabbing things that they think that they're taking can go a long way to preventing those errors and utilizing those tools and thinking about where, where can it go wrong?

33:23
Where are their barriers?

33:26
Can they see?

33:27
Can they read and working around those to prevent those errors?

33:33
Yeah, sometimes those instructions are printed so small.

33:36
I keep a pair of reading glasses in my bathroom where my medications are too, for that same reason.

33:41
So Lynn, how about how about for you?

33:46
Well, yeah.

33:47
So I would add on to some of what Rebecca has said as well.

33:51
I think that one of the things when we're developing that care plan and interventions is that we have to attend to those social determinants of health, right?

34:00
And some of the cultural issues that we might see in our patients.

34:03
Want to speak specifically here about health literacy in identifying patients that are at risk for literacy issues related to healthcare instructions.

34:14
When you look at the percentage of adult patients specifically the national assessment of the of health literacy indicates that about 36% of our patients are at a basic or below level in terms of understanding.

34:28
And then when you look at patient clinical outcomes, about 50% of our patients who are struggling with the adherence to a treatment plan are are, you know, unable to understand the way that they're supposed to take their medications.

34:45
Maybe they don't recognize the medication, maybe they don't understand the way it's written out in terms of how to take it.

34:51
So those visuals that that Rebecca had talked about in terms of time clocks or graphics, you know, bringing things down to that patient level for understanding and in a way that they can understand it or using what is called living room language to be able to explain the medications.

35:08
And in doing that.

35:09
And I think one of the things, you know, there's the obvious patients, maybe they, they, you know, we know that they, you know, come from a background where they don't have a higher level of education.

35:18
They struggle with reading and writing and, and, or a language barrier.

35:22
And we can see that.

35:24
But one of the things that is, has been striking to me, the American Medical Association has done a fair amount of research around literacy and health literacy is around the patients who are at risk for not understanding our, our, you know, our directions.

35:40
And it's, it's people 60 years and old and older, right?

35:44
I raised my hand for that, right?

35:45
Like, you know, it's not necessarily related to their educational level or their educational preparation.

35:51
It's around their age.

35:53
It can be around their, the multiple chronic conditions that they've had or the various treatment plans and the, you know, and I'd say patients, but I also say caregivers.

36:03
And then we talked about vision also hearing, right?

36:07
Can they hear and can they process the, the information that we're giving us, giving them and how do we do that best?

36:13
And so looking at those root causes.

36:16
So if we have a patient who's either resistant or they're maybe not adhering it to the plan the way that they want.

36:23
And these are things we have to build into that plan of care so that all members of the care team can understand, you know, what's important here in terms of making sure that we can, you know, you know, bring that, bring, you know, bring that into the forefront so that we all know it.

36:38
Also just making sure that we're looking at any of those other social determinants of health, the cost and the barriers to getting the medications that, you know, if they have transportation issues, those kinds of things.

36:49
And then I just want to put a plug in here for teach back.

36:54
Actually having the patient demonstrate or the family demonstrate, not telling you or walking you through it, but actually showing you what they're doing it, how they're doing it, how they're preparing the medications is very valuable.

37:07
It's very telling to see.

37:09
So just a plug for the AMA.

37:11
They have a lot of health service resources out there and most of us are now in a digital world.

37:17
So if we're doing anything digitally with patients, there's also digital literacy assessments to make sure that the patients understand things that we're asking them to do maybe on the computer or on a portal or however that information is being provided for them.

37:32
So thank you.

37:33
Those were great points to bring up Harmony.

37:37
Sure.

37:38
So when I think about care planning and interventions along the same lines as Lynn mentioned with care planning, I want to talk about a multidisciplinary approach to care planning in Hospice care, specifically the involvement of the IDT team and really to have some issues at the top of the list for specific patients, especially those who are having active changing condition And in Hospice care condition can change pretty quickly.

38:11
So really having that in the back of the ID TS mind when they're thinking about changing condition to really start to anticipate there's some happening, right, like that proactive error before reporting, but proactive error prevention.

38:29
So I, I can think of a diabetic Hospice patient who may be, you know, insulin injections were appropriate at some time in their, in their care, but as they stop or their decrease in their oral intake now this might be very dangerous for them.

38:47
So I think it is an opportunity for the team to really keep this in mind for any patient on any high risk medication.

38:55
When is it time to stop these medications and to make sure that this patient doesn't have a hypoglycemic event, let's say?

39:04
Because I always think it's it's, it happens quite often, unfortunately, for Hospice patients to have hypoglycemic events.

39:13
And so it's a very preventable way of really keeping it at the top of the care planning and at the list of the IDT team to change the plan and the medications as the patient is changing.

39:26
Yeah, looking ahead, Right.

39:28
I think that's great point.

39:30
Jennifer, you're on mute too, just to I don't know that I have much to add here.

39:37
Everybody's really done a good job into outlining this section here.

39:42
I think the only thing that I would say is, you know, trying to tailor medication regimes to that individual patient.

39:51
If you're doing that, that can help up adherence to the medication itself and taking it and reducing risks of errors.

40:03
You have to fit it into that patient's lifestyle.

40:06
You know, if they're getting up later because they're not feeling well and we have a medicine that needs to be taken three times a day, then we have to figure out how is that going to fit into the hours they are awake because their lifestyle's a little bit different because you know of whatever of it, the surgery or therapy or whatever it may be that they're receiving in the home.

40:31
So again, the tailoring to the individual needs and to what matters to them as well.

40:38
Thank you.

40:39
I'm going to, I'm going to throw a wrench and things for the my panelists here.

40:43
I'm going to combine two questions for the sake of time.

40:45
So Rebecca, I'm going to take this to you to start us off.

40:51
But there's a couple parts to this.

40:52
So the first one is about error reporting and how that impacts patient safety.

40:57
And I know Armani kind of touched on that a little bit in our last slide.

41:00
So if you want to add a little bit to that as well.

41:03
But I also want to have you touch on how protocols to maintain medication accuracy as how we can do that well when especially when we're transitioning between care settings.

41:17
So when we're dealing with a lot of our patients, on average they have 11 to 20 medications and that doesn't include what's already been discontinued and put back because it failed.

41:31
And so making sure that they get the right medication at the right time and that we take out those things, for instance, in a transition when the hospital says, OK, this is what's on our formulary.

41:46
So instead of urinalopril, we're going to do lisinopril.

41:51
And now when they're discharged, if they're both on their Med list.

41:55
So which one do you take?

41:56
So just making sure that those changes from formulary are really discontinued and notified.

42:06
And then when there is an error, the, as Armin said, the importance of reporting it and taking rather than looking at that as a negative, making it a positive and turning it into, well, what can we do to prevent this?

42:21
So having those triggers when we see a duplication of therapy to look back and see, OK, why are they on the enalapril and the lisinopril?

42:31
Why are they on foreign and inhalers that are all the same medication and then educating and pulling off?

42:39
But having those triggers at that point of polypharmacy or duplications of therapy can be very helpful.

42:45
So really looking at those errors as a chance to improve our processes rather than making it a punishment.

42:55
Absolutely.

42:56
Lynn, can you touch on these two areas for us?

43:00
Yeah, so I'll just kind of chime into the underreporting category right here that we were just talking about.

43:07
You know, this is a significant opportunity for the home care and Hospice space where we're really encouraging.

43:14
Like Armani had said earlier, you know, those, those, those things that we come across that the Med era didn't actually happen.

43:21
There wasn't an adverse event, but we came across something that could have been right, might maybe would have been an error.

43:27
And there's a variety of reasons why we don't do that.

43:29
One is it's just ease of access to doing the reports out in the field, the fear of being, you know, punished for completing, you know, having an error that might have happened or could have happened and, you know, just inadequate systems, right?

43:43
And or not knowledge about what those error, those reporting processes are.

43:48
And some of the ways to mitigate that around like when we talked about protocols and protocol development around the best practices are to one, engage your staff in this, right?

43:59
So if they understand that we're trying to improve things from a safety perspective and the value and the importance of this, having them be a part of that protocol development and that policy development so that we're listening to them.

44:12
We're hearing what's going to be effective in the field.

44:15
And then utilizing whatever those checklist systems are or processes are to be able to help people understand.

44:22
These are the steps that we want to take, you know, take or do when each of those visits to assure that we're, you know, adhering to a process that's going to be safe for those patients.

44:31
And then making sure that when we're thinking about those policies and we have some clear definitions about what is a Med error, because I think you, you know, when you look at the literature, there isn't a clear definition.

44:45
You know, these are all studied in acute care settings, but when you look in primary care and outpatient settings like Hospice, it's not clear what is an error.

44:53
And so people, you know, don't always think of what they see or what they do as an error.

44:58
So having some organizational standards about definitions of that.

45:02
And then every error should be debriefed upon so that we learn from it.

45:06
We can, you know, prevent those from happening before.

45:09
So again, ultimately our goal is to have provide safe patient care in a way that's going to help patients at this end of life stage.

45:17
Absolutely.

45:18
Thank you.

45:19
Jennifer, do you want to add to these two areas?

45:22
Yeah, I would say, you know, if an organization is truly functioning in a continuous quality improvement format, then the, the bringing forth of any kind of gap is what needs to happen in order for performance improvement to happen.

45:42
So asking those continuous questions, how are we doing, what can we do better?

45:47
And if we, you know, to Lynn's point, if our, our staff don't understand what a Med error is or when they should report a Med error, we're never going to get to that, that continuous quality framework peak that we want to get to.

46:05
The other thing that I, I think particularly in Hospice and palliative care, the transition between care settings is really important.

46:16
We need to understand what the drug profile is when they're coming on to Hospice care.

46:24
We need a complete picture of that in order to do that Med rec and then do that de prescribing in a tandem with Rebecca, the pharmacist and the attending physician, if there is one, and the Hospice physician in order to reduce pill burden on the patient essentially.

46:48
So I think it's really important when we're looking at using some tools that might be out there.

46:58
Structure communication tools such as an S bar might be helpful when you're looking at transition between two different care settings and to ensure that you have clear and consistent information exchange between the two care setting teens so that high risk patients, high risk medications can be identified right from the get go.

47:23
Great, thank you.

47:24
Normne, will you close this out?

47:27
Sure.

47:28
The only thing I mean all of the all of these have been great.

47:31
The only thing I would add to the discussion is the value of near misses.

47:37
The value of really reporting near misses before errors occur and really making sure that these are valuable learning opportunities for the staff so that once near misses are reported, then it can later prevent any kind of actual error.

47:57
So I would say that's very valuable.

48:00
And during transitions of care, one thing I want to stress is the importance of making sure that patient's home binder is always up to date.

48:09
Because when when in an emergency, in a hospitalization, when they leave to go to their next level of care, most often that's the first thing that they may take with them is that medication profile before the organization can have a chance to send the profile to facilities is to really make sure that that information is up to date and accurate as as much as possible.

48:35
Sometimes there could be some delays in getting the most up to date care plan or Med profile to the patient's home.

48:42
But during transitions, that's very important.

48:46
Right.

48:46
Thank you.

48:47
Now I'm going to keep us moving here because I want, this is a really important part of our conversation is, is around outcomes and best practices.

48:53
So we really want to talk about how we can maximize the outcomes that we're looking for and talk about some of those emerging best practices and tools that support ensuring patient safety and continuous improvement in medication management.

49:08
I want us to be aware of our timing so that we make sure we leave a few minutes for questions at the end of our session.

49:14
So I'm going to ask each of you to leave your responses slightly brief in nature, but let's talk a little bit more about what some actionable steps are that we can take to move an agency in the direction, in that direction that we're headed.

49:28
Right?

49:28
Build it, building a culture of safety.

49:31
Jennifer, do you want to get us started on that topic?

49:35
Yeah.

49:36
So I think the culture, the culture of safety begins with a culture of quality and that is built in culture of safety is built into your culture of quality.

49:48
And that really starts from the top down and all of the leadership models that throughout the organization.

49:56
So the organization that that accomplishes that proactively plans for resources to support quality and therefore ergo patient safety.

50:10
And I'm meaning staffing, I'm meaning financial and all of the above.

50:15
And I think the tools that support that patient safety are one, you determine what standards of practice you're going to adopt, what evidence based tools afford assessment that you you as an organization or going to adopt and utilize.

50:35
And also that you are continuously evaluating and educating your staff and not just expecting them to know things that that means when they come into the organization at orientation, you're orienting them and educating them to the organization's expectations in making sure that they utilize evidence based tools the correct way and apply them the correct way and also in continuing education as well.

51:07
So I'll pass it back to you, Denise, Thank you.

51:10
I'm going to, I'm going to pass it over to Arminane to take us up on that.

51:15
When I think of culture of safety in an organization, I think of fostering an accountable but a non punitive environment where mistakes and are seen as opportunities instead of a blame game, right.

51:31
So I think it's never a person problem, it is a system problem.

51:36
So it's very encouraged to make sure staff feel empowered to speak up about any risks or concerns without any fear of any kind of a blame on retaliation and leadership engagement and support of of this is very important.

51:56
And to make sure if you can walk away with one advice I may give is to always audit, audit everything.

52:05
So then you can identify any kind of gaps in your practices to support this.

52:11
Because I, I can't help but think of the Swiss cheese model every time you think about patient safety and the layers of the cheese, we think of those as like a layer of policy, layer of education, a layer of.

52:23
And when there are holes and gaps, errors happen when those holes align right.

52:28
And so really identifying where are these holes and gaps and closing them is the way that an organization can prevent patient harm.

52:41
And that's done through quality programs and continuous auditing.

52:46
I love that analogy.

52:48
Thank you, Rebecca.

52:50
I really don't have much more to add except to say and don't become complacent because the minute we become complacent, that's when those errors and mistakes are going to happen.

53:05
We have to stay on top of it.

53:06
We have to continually look to better our processes to prevent those errors and just complacency is where the errors occur.

53:19
Excellent, Lynn, I think there are a couple of opportunities here.

53:23
1 is trying to make the right thing the easiest thing to do.

53:26
So are there opportunities for using technology to capture data and you know, incidents out in the field so that it's point of care so it's easier for people to report those things.

53:38
And then the other is in terms of best practices, you know, one opportunity we have as a collective group of learners in this industry is how do we work together?

53:46
And one strategy is by exploring what patient safety organizations out there and is it a time that your organization would be interested in joining a patient safety organization?

53:59
The opportunity that exists with the PSO is bringing the collective group within an industry together to, to, you know, aggregate data across all, you know, organizations so that we can start to establish some benchmarks and opportunities and collectively work together to develop those best practices around medication, you know, adherence and medication safety practices as well as other, you know, safety initiatives as well.

54:26
And so if you haven't heard of a PSOHRQ agency for healthcare research and quality, there's a number of PS OS that are out there that you know, are are, you know, helping organizations be able to collectively learn from each other and aggregate that data and establish some benchmarks for improvement opportunities.

54:47
Thank you.

54:48
You know, my next question that I was going to punt to you was actually about where agencies should focus their energy and time investment to ensure they're maximizing patient safety.

54:57
It sounds like that the PSO might be a good place for that.

55:00
Any other suggestions from you, Lynn?

55:03
I think it starts with a self-assessment, right?

55:05
Looking in the mirror and really taking a hard look at what you do have.

55:10
How are you doing it?

55:11
If you're in a leadership role and you have very few incident reports on medication errors, I mean, it like Armani's points, you know, we're not capturing those near misses and there are a lot of systems issues that contribute to, you know, our our staff's ability to provide safe care.

55:29
But sometimes it's just awareness.

55:31
And So what is, you know, how do you do that and do that self-assessment and then come up with your policies, your procedures, and then your debriefings, really look at all those events so that you can, you know, establish best practices within your organization and support your staff to provide safe patient care for best outcomes.

55:50
Thank you.

55:51
I'm just going to ask if anyone else would like to contribute or has an has a thought or idea around that that same question.

56:03
If not, I'm going to move us on to questions from our audience members.

56:08
We have quite a few actually.

56:10
So one of our questions was really around the focus on Hospice care.

56:14
So I would just ask any of our panel members if you feel like anything was really significantly different here in the application towards home health, for example, or other community based care models.

56:27
Everything we talked about today and really apply to any care provided in a patient's home and in home health.

56:36
In home health, especially where patients may be going in and out of the hospital, often it is a lot more important to make sure that medications are coming, You know which doctors are prescribing, there are multiple doctors, so there are even more opportunities for medication management issues.

56:57
So home health organizations just like Hospice should have, should really adhere to all of these best practices we discussed today.

57:06
I would add to that, I would add to that just tightening that relationship with the home care patients, PCP and PCP practice as well, because that relationship is very valuable in terms of understanding the meds and the Med changes.

57:21
And you know, you know what, what the patient, what needs to be folded into that patient plan of care.

57:28
Yeah, a lot of specialists typically involved in that or can be involved in that as well.

57:32
So that adds to it too.

57:33
Yeah.

57:34
Well, Jennifer, I wanna ask.

57:35
Oh, I'm sorry, go ahead.

57:36
Oh, I was just gonna add on quickly from a survey point drug profile is is highly cited as one of the highest sided survey deficiencies.

57:48
So it is something that all organizations, whether home health or Hospice really need to to work on, one, assessing for gaps and two, monitoring and ensuring that their drug profiles are always updated.

58:05
Yeah, thank you.

58:06
Well, and actually on that same note, I wanted, there's another question which is actually around insuring survey or insurance compliant insurance compliance for a survey.

58:16
So the question was really about like what if you have those old medications and the patient doesn't want to get rid of them?

58:23
How should the clinician appropriately document for that to ensure there is compliance around that from a survey standpoint?

58:35
You know, we what what a survey will be looking for is what are the medicines it you know the patient is actively taking?

58:45
Are they on the drug profile, you know, are route, dosage, etcetera, etcetera all mapped out on that?

58:53
Does the drug profile in the clinical record match the drug profile in the patient's house?

59:00
If the patient is not taking medicines, As I said before, the DEA clearly has stated that the patient owns the medicines.

59:09
OK.

59:10
We in the home can make the best case possible for them to move those medicines along to drug disposal.

59:19
Whether it's buying a canister to make them inactive, Kitty litter, coffee, or you know there's canisters that you can buy with chemicals in them that make the drugs inactive.

59:32
Or having the patient or the caregiver take them to a drug drop off or a a spot at a pharmacy or drug drop off day that might be sponsored by their community.

59:45
But we can't make them get rid of stuff that's beyond, you know, what we do in the scope of practice in in the home.

59:55
Thank you.

59:56
Really quick before I have any of you add, I know someone in our audience has raised their hand and I just want to the the you're muted and.

1:00:03
You can't unmute yourself in this format.

1:00:05
So if you'd like to post a question, please use the Q&A for that and be happy to to address the question for you.

1:00:11
Would anyone else like to add to that question though?

1:00:15
I, I will add to that, that if they don't want to destroy that medication that they're not taking, at a minimum make sure it's isolated away from what they're taking regularly.

1:00:27
So a medication here does not occur.

1:00:30
Yeah, I agree with that.

1:00:31
Rebecca, thanks for adding that on.

1:00:33
Yeah, I always say there could be like a box of active medications that matches your profile.

1:00:39
And then they're welcome to save their medications outside of this active medication.

1:00:44
Or sometimes, like organizations can use stickers on the bottom of the medications, like green is active, red is inactive.

1:00:51
And then this could then if the family wants to hang on to the actual bottles, then there's a way of tagging the inactive ones.

1:00:59
Good toy.

1:01:00
Thank you.

1:01:02
I'm going to I'm going to allow us to take just one more question and I'm going to read you the whole question here.

1:01:08
So the question is really related to the complication of patient goals and how that can be difficult.

1:01:15
So you know, when we're prioritizing goals, how do you prioritize while still meeting compliance around the plan of care?

1:01:23
And the example could here could be that.

1:01:28
So every treatment becomes a goal, but that can be very long and overwhelming for the patient.

1:01:34
So if the patient is more concerned with like say in the example given nausea and vomiting versus the pain, are we recommending that we not include pain as a plan as part of the plan of care as a way to prioritize those goals?

1:01:48
So can we get a little bit of clarification around, I mean that was a great example, but a little bit of clarification around that you can take an attempt at it, right.

1:01:59
Thank you.

1:01:59
When we think of when we think of goal setting, you can think of it couple ways.

1:02:06
There are short term goals and long term goals.

1:02:09
So there are those initial goals that you want to meet right away and this has to do most often with symptom management.

1:02:18
And then some goals can be long term goals.

1:02:20
So even though you have a long list of goals, not all of them needs to be prioritized right away.

1:02:26
So you can have those goals that you meet within two weeks, then within maybe 4 weeks, then within nine weeks.

1:02:33
And you can also divide goals by acute kind of something that's acute for at risk for, right?

1:02:43
So you can have acute pain where you need to manage this pain within 48 hours.

1:02:50
That means patient is in pain and the patient does not currently have a medication that needs to that can support this pain.

1:02:59
So that acute goal would be within 48 hours.

1:03:03
But after that acute goal is met, you may have an ongoing goal of pain, for example, that the patient is at risk for pain and maybe at risk for the pain medication regimen to not work anymore or require more.

1:03:20
So what's really important are the interventions in goals in in these goals and these care plans to really assess, do comprehensive assessments.

1:03:30
For example, in pain management, when a patient says I have 0 pain, what does that mean?

1:03:36
0 pain?

1:03:37
Because I haven't had pain or zero pain.

1:03:40
I have taken every single dose of PR and pain medications I have at home.

1:03:44
So it's really about really assessing and putting and thinking about goals that way, right.

1:03:53
Thank you.

1:03:53
I think that helped a lot.

1:03:55
While we are at time, we're actually about four minutes overtime.

1:03:57
So this was really a robust conversation.

1:04:00
And I can't thank our panelists enough for their expertise that they brought to this topic.

1:04:04
We hope that our audience was able to learn some strategies and tactics to help ensure that they're maximizing patient safety because patient safety is everyone's responsibility.

1:04:14
So with that, I just want to say thank you for all of to all of you that have joined us today again, and thank you to our panelists.

1:04:21
A copy of a recording, a recorded version of this presentation will be available to anyone who has attended or registered the for the event.

1:04:30
And in addition to that, we'll also post it on our chap webinar YouTube site if you'd like to share it with others.

1:04:35
So we thank you all very much and we hope you have the great rest of your day and do something towards patient safety in in the ignition of Patient Safety Awareness Week.

1:04:47
Thank you so much.

1:04:49
Thank you.

1:04:49
Thanks everyone.