Development and validation of the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE)

Esa YH Chen,1,2 Janet K Sluggett,1,2 Jenni Ilomäki,1,3 Sarah N Hilmer,2,4 Megan Corlis,2,5 Leonie J Picton,1 Laura Dean,1 Christopher P Alderman,6 Nicholas Farinola,7 Joy Gailer,8 Jane Grigson,5 Andrew R Kellie,9 Peter JC Putsey,5 Solomon Yu,10 J Simon Bell1–3 1Centre for Medicin...

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Autores principales:	Chen EYH, Sluggett JK, Ilomäki J, Hilmer SN, Corlis M, Picton LJ, Dean L, Alderman CP, Farinola N, Gailer J, Grigson J, Kellie AR, Putsey PJC, Yu S, Bell JS
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Medication therapy management Long-term care Geriatrics Drug administration Medication regimen complexity RC952-954.6
Acceso en línea:	https://doaj.org/article/352c0120ac184f3882a18db93c5bf8d0
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record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	Medication therapy management Long-term care Geriatrics Drug administration Medication regimen complexity Geriatrics RC952-954.6
spellingShingle	Medication therapy management Long-term care Geriatrics Drug administration Medication regimen complexity Geriatrics RC952-954.6 Chen EYH Sluggett JK Ilomäki J Hilmer SN Corlis M Picton LJ Dean L Alderman CP Farinola N Gailer J Grigson J Kellie AR Putsey PJC Yu S Bell JS Development and validation of the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE)
description	Esa YH Chen,1,2 Janet K Sluggett,1,2 Jenni Ilomäki,1,3 Sarah N Hilmer,2,4 Megan Corlis,2,5 Leonie J Picton,1 Laura Dean,1 Christopher P Alderman,6 Nicholas Farinola,7 Joy Gailer,8 Jane Grigson,5 Andrew R Kellie,9 Peter JC Putsey,5 Solomon Yu,10 J Simon Bell1–3 1Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia; 2NHMRC Cognitive Decline Partnership Centre, Sydney Medical School – Northern, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia; 3Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; 4Kolling Institute, Sydney Medical School, The University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia; 5Helping Hand Aged Care, North Adelaide, SA, Australia; 6School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia; 7Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia; 8Drug and Therapeutics Information Service, Repatriation General Hospital, Daw Park, SA, Australia; 9East Adelaide Healthcare, Newton, SA, Australia; 10Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville South, SA, Australia Background: Residents of aged care facilities use increasingly complex medication regimens. Reducing unnecessary medication regimen complexity (eg, by consolidating the number of administration times or using alternative formulations) may benefit residents and staff. Objective: To develop and validate an implicit tool to facilitate medication regimen simplification in aged care facilities. Method: A purposively selected multidisciplinary expert panel used modified nominal group technique to identify and prioritize factors important in determining whether a medication regimen can be simplified. The five prioritized factors were formulated as questions, pilot-tested using non-identifiable medication charts and refined by panel members. The final tool was validated by two clinical pharmacists who independently applied the tool to a random sample of 50 residents of aged care facilities to identify opportunities for medication regimen simplification. Inter-rater agreement was calculated using Cohen’s kappa.Results: The Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) was developed as an implicit tool comprising of five questions about 1) the resident; 2) regulatory and safety requirements; 3) drug interactions; 4) formulation; and 5) facility and follow-up considerations. Using MRS GRACE, two pharmacists independently simplified medication regimens for 29/50 and 30/50 residents (Cohen’s kappa=0.38, 95% CI 0.12–0.64), respectively. Simplification was possible for all residents with five or more administration times. Changing an administration time comprised 75% of the two pharmacists’ recommendations.Conclusions: Using MRS GRACE, two clinical pharmacists independently simplified over half of residents’ medication regimens with fair agreement. MRS GRACE is a promising new tool to guide medication regimen simplification in aged care. Keywords: medication therapy management, long-term care, geriatrics, drug administration, medication regimen complexity
format	article
author	Chen EYH Sluggett JK Ilomäki J Hilmer SN Corlis M Picton LJ Dean L Alderman CP Farinola N Gailer J Grigson J Kellie AR Putsey PJC Yu S Bell JS
author_facet	Chen EYH Sluggett JK Ilomäki J Hilmer SN Corlis M Picton LJ Dean L Alderman CP Farinola N Gailer J Grigson J Kellie AR Putsey PJC Yu S Bell JS
author_sort	Chen EYH
title	Development and validation of the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE)
title_short	Development and validation of the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE)
title_full	Development and validation of the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE)
title_fullStr	Development and validation of the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE)
title_full_unstemmed	Development and validation of the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE)
title_sort	development and validation of the medication regimen simplification guide for residential aged care (mrs grace)
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/352c0120ac184f3882a18db93c5bf8d0
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spelling	oai:doaj.org-article:352c0120ac184f3882a18db93c5bf8d02021-12-02T01:18:39ZDevelopment and validation of the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE)1178-1998https://doaj.org/article/352c0120ac184f3882a18db93c5bf8d02018-05-01T00:00:00Zhttps://www.dovepress.com/development-and-validation-of-the-medication-regimen-simplification-gu-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Esa YH Chen,1,2 Janet K Sluggett,1,2 Jenni Ilomäki,1,3 Sarah N Hilmer,2,4 Megan Corlis,2,5 Leonie J Picton,1 Laura Dean,1 Christopher P Alderman,6 Nicholas Farinola,7 Joy Gailer,8 Jane Grigson,5 Andrew R Kellie,9 Peter JC Putsey,5 Solomon Yu,10 J Simon Bell1–3 1Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia; 2NHMRC Cognitive Decline Partnership Centre, Sydney Medical School – Northern, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia; 3Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; 4Kolling Institute, Sydney Medical School, The University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia; 5Helping Hand Aged Care, North Adelaide, SA, Australia; 6School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia; 7Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia; 8Drug and Therapeutics Information Service, Repatriation General Hospital, Daw Park, SA, Australia; 9East Adelaide Healthcare, Newton, SA, Australia; 10Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville South, SA, Australia Background: Residents of aged care facilities use increasingly complex medication regimens. Reducing unnecessary medication regimen complexity (eg, by consolidating the number of administration times or using alternative formulations) may benefit residents and staff. Objective: To develop and validate an implicit tool to facilitate medication regimen simplification in aged care facilities. Method: A purposively selected multidisciplinary expert panel used modified nominal group technique to identify and prioritize factors important in determining whether a medication regimen can be simplified. The five prioritized factors were formulated as questions, pilot-tested using non-identifiable medication charts and refined by panel members. The final tool was validated by two clinical pharmacists who independently applied the tool to a random sample of 50 residents of aged care facilities to identify opportunities for medication regimen simplification. Inter-rater agreement was calculated using Cohen’s kappa.Results: The Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) was developed as an implicit tool comprising of five questions about 1) the resident; 2) regulatory and safety requirements; 3) drug interactions; 4) formulation; and 5) facility and follow-up considerations. Using MRS GRACE, two pharmacists independently simplified medication regimens for 29/50 and 30/50 residents (Cohen’s kappa=0.38, 95% CI 0.12–0.64), respectively. Simplification was possible for all residents with five or more administration times. Changing an administration time comprised 75% of the two pharmacists’ recommendations.Conclusions: Using MRS GRACE, two clinical pharmacists independently simplified over half of residents’ medication regimens with fair agreement. MRS GRACE is a promising new tool to guide medication regimen simplification in aged care. Keywords: medication therapy management, long-term care, geriatrics, drug administration, medication regimen complexityChen EYHSluggett JKIlomäki JHilmer SNCorlis MPicton LJDean LAlderman CPFarinola NGailer JGrigson JKellie ARPutsey PJCYu SBell JSDove Medical PressarticleMedication therapy managementLong-term careGeriatricsDrug administrationMedication regimen complexityGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 13, Pp 975-986 (2018)

Development and validation of the Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE)

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