​Any medication management initiative should focus on critical therapeutic categories, unnecessary medications, and the justification of psychopharmacologic meds. 

The BID (twice-daily) med pass initiative at The Pines, and other Genesis centers throughout the company, combined these initiatives and added components intended to increase staff efficiency and satisfaction as well as resident quality of life. Sound medical principles were used to evaluate medication profiles with the goal of optimizing medication administration timing and reducing unnecessary medications. 

John Loome, MD, chief medical officer for Genesis says, "One of the benefits of this initiative is its focused  attention on the principles of medication management and F-tag 329 by integrating  medication review and ongoing reduction of unnecessary meds into daily clinical processes.”

Getting Started

Always keep in mind that the guiding principle of any BID Med Pass Initiative is to perform a team evaluation of the current medication regimen with the goal of clinically appropriate, resident individualized, safe changes with the prescriber’s authorization and with follow-up monitoring to assess the resident’s reaction to the change;

Here a few tips on implementing a safe and successful BID med pass initiative:

• Form a team: Achieving success requires a team effort and that team must include your key clinical staff members.
• Check the regulations: Ensure that your process complies with applicable regulations and payor requirements.
• Consult with the resident council and staff:  Ask the users how they would like to see things change
• Update policies: Incorporate a med pass policy if you do not already have one.
• Develop center operations processes to “sell” the plan:
• Keep staff, patients, families and resident council informed;
• Communicate with and engage the medical director and prescribers; and
• Provide necessary education.
• Develop clinical processes to ensure safe practice:
• Review medication regimen for each patient.
• Look for opportunities to reschedule using new times , identify duplicate therapy and consider long acting dosage forms.
• Communicate proposed changes to prescribers.
• Document approval for changes, such as new orders or progress note.
• Do follow up monitoring and lab monitoring if indicated.
• Develop external processes to gain assistance and expertise from available resources. From the pharmacy consultant perspective, Beth Coryea, PharmD, senior director of program development for Omnicare National Accounts, says, “Pharmacists are medication experts who serve as a key resource to center management and nursing staff transitioning to this model in the planning phase, through implementation and importantly, the follow up monitoring phase.” 
• Utilize the services of the consultant pharmacist who can act as a clinical resource regarding med schedules and provide guidance on appropriate administration times and dose consolidation.
• Create a tool kit that provides what’s needed to get the job done. This kit might include
   the following:
• A step-by-step process guide;
• Template letters to families and physicians announcing the program and its benefits; and
• Clinical resources and in-service materials, including guidelines on timing for safe and effective medication administration.
• Begin to develop alternative work flow processes for nursing staff.

A Worthwhile Initiative

Not all medications fall into this seemingly neat BID package. Several medications must be administered multiple times  a day to patients. And a BID med pass program works best with long-term residents. Medication regimens for short-stay patients, for example, those being care for in a tertiary care unit, might only be reviewed for dosing consolidation.

So, might it be a worthwhile initiative? From a leadership perspective, the answer is yes. Malenda Hoelscher, director of nursing at Mountainview Center in Rutland, Vt., the first Genesis BID med pass center, says, “What excites me the most about this initiative is that it truly embraces both resident choice and resident voice…the initiative in our center was resident-driven and yet from a leadership standpoint has also positively impacted clinical outcomes and nursing satisfaction. A true WIN-WIN for everyone involved.”

Marylee Grosso, RPh, is a senior director of clinical operations for Genesis HealthCare. A clinical pharmacist with over 25 years experience in the long term care industry, Grosso is responsible for corporate medication therapy management initiatives. She can be reached at Marylee.grosso@genesishcc.com or (978) 247-5190.