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 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.
- 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.
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.
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.
- 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.
- Review reasons for increased risk of adverse drug events (ADEs) in elderly patients, including:
- Transitions in care
- Renal decline
- 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.
- 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.
- 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.
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.