VNAA CHAMP


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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.

Unit Objectives

  • Review the 3 purposes for measurement in improving care
  • Assess current medication management performance by conducting chart reviews for 10 elderly patients
  • Compare performance at the team, agency, region, 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 nine 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 the causes of variation and understand why it is important to identify the cause before proceeding with an improvement effort
  • 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 nine CHAMP measures to bring to the first face-to-face workshop.


Unit 3: Mastering Medication Assessment and Reconciliation

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

Unit Objectives

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

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

Assignment: Assess current medication assessment and 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 advance 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 - Progress Point 1

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

Unit Objectives

  • Conduct a chart review for 10 additional patients
  • Review performance data results and reflect 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.

Assignments: 1) Complete chart reviews for Progress Point 1 using the same process as in Unit 1; and 2) 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 seniors.

Unit Objectives

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

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 the elderly
  • 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 a patient-centered communication technique, based on the Stages of Change, known as motivational interviewing to staff.


Unit 8: Measuring Performance - Progress Point 2

Conduct a final 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 elderly patients, using the same process as in Units 1 and 5; and 2) develop a written plan for post-CHAMP activities to sustain and build on gains.


Post-Test

The Pre-test is re-administered as a Post-Test to assess changes in knowledge of key components of geriatric medication management, managing for quality, and teambuilding.