BID Med Pass Project
Michael D. Crowley, MD, FAAFP,CMD
Joan Gannon, RN, CDONA/LTC
Stacey Radcliffe, MGS, NHA
The Pines Center
Genesis Healthcare Corporation
Long Term Care Medicine – 2011
 March 24-27, 2011  Tampa, Florida

 Describe the value of a BID Med Pass
System
 Explain how the clinical team can accomplish this initiative
 List ways this process can
 Increase compliance with regulatory codes
 Enhance staff performance
 Positively affect every day routine for staff
 Increase staff and resident satisfaction

A BID Med Pass Schedule is developed to consolidate medication administration times for long term care patients, where clinically appropriate, to minimize unnecessary medications and the numbers of medications which require administration outside this schedule.

Quality Improvement / Quality of Life
Project
 How many times do we approach a resident for medication administration? An example:
 Colace 2x/day: 9am & 5pm
 Seroquel at bedtime: 9pm
 Nifedipine qd: 9am
 Alphagan tid: 6am-2pm-10pm
 Natural Tears qid: 6am-12pm-6pm-12am
 6am-9am-12pm-2pm-5pm-6pm-9pm-10pm
8 times / day

Quality Improvement / Quality of Life
Project
 Decrease daily interruptions for the residents
 Improve sleep
 Fewer therapy or activities interruptions

Reduce “wait around” time for med administration
 Increase nursing time spent for
 non-medication related care and time spent with residents
 supervision and support of staff
 Reduce unnecessary meds / ADR potential
 Increase Resident and Family Satisfaction

Achieving success requires
 Team effort
 Administrator
 Director of Nursing/Assistant Director of Nursing
 Medical Director, Nurse Practitioner, Attending
Physicians
 Consultant Pharmacist
 Nursing Staff and Certified Medication Aides

 Regional Clinical Services Manager
Measured approach – one unit at a time
 Communication with all stakeholders

 Review each patient’s Medication Record for
 Rescheduling meds according to new med pass times
 Duplicate drug therapy, ineffective drugs


 Safe changes of TID and QID orders to long acting BID dosage forms, if available


Reschedule BID, TID and QID orders to maximize overlap
Close review of drug regimens to eliminate unnecessary drugs/dose, ensure gradual dose reductions
Optimize resident specific needs, eg. timing of tube feeding
Close and constant collaboration with physicians
 Pre-change Discussion; Chart Documentation
 Follow up with effect of change (+ and -)

 How many times do we approach a resident with medication administration post BID Med
Pass?
 Seroquel at bedtime: 9pm
 Nifedipine qd: 9am
 Change BID Colace to Senna plus at bedtime: 9pm
 Change Alphagan tid times: 9am-2pm-9pm
 Decrease Natural Tears to tid: 9am-2pm-9pm
(eliminate 12pm dose)
 9am - 2pm - 9pm
Reduced from 8 to 3 times per day

 Three LTC Units – 115 Residents
 101 Medication Regimens Converted or
Consolidated to a BID Schedule
 88% Conversion Rate
 Remember All medications may not “fit”

15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
Change in Avg # Rx/Pt/Mon with BID Med Pass
Project = 12.1 to 9.5
June December
June 2010 v s De ce mbe r 2010

Before Implementation of BID med pass project
Medication Pass
Lunch/Break
Documentation
Assist other Nrsg
Assistants with patient care
After implementation of BID med pass project
Medication Pass
Lunch/Break
Documentation
Direct Patient Care



Regulatory Compliance – Recent Survey
Results
Quality of Patient Care Services – Improved
Customer Satisfaction by 8%
 Positive Resident Council Reports
 Care Giver Model Initiated with Additional
Staff Hours
 Enhanced Dining Program
 Improved Staff Satisfaction by 12%
 SUCCESS!

BID Med Pass – Not a Financial
Improvement Project BUT
Project Implemented April - June 2010
 Avg Medication Cost Per Pt Per Month
 6 Mon Avg Ending June 2010 = $419/Pt/Mon
 6 Mon Avg Ending Dec 2010 = $308/Pt/Mon

↓ $110 Avg Medications Cost per patient per month
*
Order data includes all payors (medicaid, medicare, insurance, pvt pay)