Pre-Test

A 13-question pre-test measures participant baseline knowledge of key components of geriatric medication management, managing for quality, and teambuilding.

Unit 1: Measuring Performance

Participants conduct baseline measurement to help them understand their staff's current performance in medication management, and to select and plan focused improvement activities.

• Review the 3 purposes for measurement in improving care
• Assess current medication management performance by conducting chart reviews for 10 older adult patients
• Compare performance at the team, agency and CHAMP-wide level by reviewing real-time data reports
• Reflect on present levels of performance and determine where improvement may be possible
  

Assignment: Complete a baseline chart review for 10 patient records, using a standardized tool. Results are entered on-line, providing immediate feedback of results for measures related to medication management.

Unit 2: Managing for Quality Improvement and Teambuilding

Strengthen knowledge and application skills in two key areas necessary for performance improvement efforts: teambuilding and managing for quality.

Unit Objectives

• Review key principles for fostering teambuilding and managing for quality, including:
  
  • Creating trust
    
  • Developing and achieving team goals
    
  • Supporting communication and information sharing
    
  • Influencing staff to make changes
    
• Learn about Aim Statements (a description of the accomplishments expected) as the first step in a successful improvement effort
  

Assignment: Draft a quality improvement Aim Statement for at least one of the CHAMP measures to bring to the face-to-face workshop.

Unit 3: Mastering Medication Assessment and Reconciliation

Describes a 3-step process (Verify, Clarify, Reconcile) for a comprehensive medication reconciliation for elderly patients admitted to home care.

Unit Objectives

• Review the process for conducting medication reconciliation for older home care patients
  

• Receive tools and strategies to identify and address common medication problems in older persons, including therapeutic duplication, drug-drug interactions, and inappropriate medications
  

Assignment: Assess current medication reconciliation performance. Conduct a test of change for at least one specific area of the process in need of improvement.

Unit 4: Managing MD Communication

Explore strategies to improve communication with physicians and other advanced practice clinicians about medication-related issues.

Unit Objectives

• Review the importance of effective collaboration with physicians for geriatric med management
  

• Develop and strengthen systems of communication with physicians
  

• Receive tools and strategies improve communication, including:
  

  • Staff exercises to help them focus their message and practice listening
    

  • SBAR (Situation - Background - Assessment - Recommendation), an evidence-based technique for communicating medication - related issues to physicians
    

Assignment: Test a change to enhance or develop a system of communication with physicians. Practice the SBAR technique with another CHAMP participant and then introduce it to staff.

Unit 5: Measuring Performance - Assessing Progress

Assess progress toward medication improvement aims and focus on accelerating improvement work.

Unit Objectives

• Reflect on results to date and on implications for improvement efforts
  
• Learn the Diffusion of Innovation Theory. Use concepts from this model to accelerate improvement efforts, particularly "adopter categories", which explain the rate at which specific individuals adopt innovations.
  

Assignment: Classify staff using adopter categories, then plan improvement activities using this information.

Unit 6: Monitoring for Complications

Review ways to improve the process of identifying and intervening in potential medication-related complications for older persons.

Unit Objectives

• Review reasons for increased risk of adverse drug events (ADEs) in older patients, including:
  
  • Transitions in care
    
  • Renal decline
    
  • Polypharmacy
    
• Learn the most common causes of ADEs in older persons: medicine/medicine interactions and medicine/disease interactions
  
• Receive tools and strategies to identify and address common med-related complications in older home care patients
  

Assignment: Identify an opportunity to improve monitoring for medication-related complications and implement at least one change presented in the unit.

Unit 7: Maintaining Adherence

The importance of adherence to medication regimens and common reasons for non-adherence are explored.

Unit Objectives

• Learn dimensions of non-adherence to long-term therapies, and a number of factors specific to medication non-adherence in older persons
  
• Review the importance of assessing for medication non-adherence at start of care and throughout the home care episode
  
• Receive tools and strategies to address medication non-adherence due to financial concerns and knowledge deficits
  
• Learn a model for the behavior change process - the Transtheoretical Model of Change, or Stages of Change

Assignment: Introduce staff to a patient-centered communication technique, Motivational Interviewing, based on the Stages of Change.

Unit 8: Measuring Performance - Course Completion

Conduct a repeat chart review to assess progress toward medication management improvement aims and develop plans for holding the gains post-CHAMP.

Unit Objectives

• Conduct a chart review for 10 additional patients and assess the progress made toward improvement aims over the course of the CHAMP program
  
• Learn more about two dimensions of change:
  
  • The people implementing the change
    
  • Attributes of the changes themselves

Assignments: 1) Complete chart reviews for 10 older patients, using the same process as in Unit 1; and 2) develop a written plan for post-CHAMP activities to sustain and build on gains.

Post-Test

A Post-Test is administered to assess changes in knowledge of key components of geriatric medication management, managing for quality, and teambuilding.