Since 2008, CMH has partnered with Wilson Pharmacy to provide a medication program for patients, to assist with medication administration along with medical and social rehabilitation. The program does not have the resources for 24-hour nursing support, leaving tenant support workers with the responsibility of administering medications and serving as first responders to the needs of complex clients. With budget cutbacks, there has been further reduction of nursing staff at facilities, resulting in more responsibilities for mental health workers in managing medications. Coincidentally, incoming admissions to the program have been increasingly complex in nature.
Since 2013, NLMM has allowed Wilson Pharmacy to deliver leading edge pharmacy services to over 350 patients enrolled in the CMH Medication Program. Not only has the medication program been accredited with exemplary standing, it is truly a cost-effective model that optimizes existing resources to deal with challenging issues. In addition to drug distribution services, the pharmacy would provide clinical support to clients and staff involved in the medication program. This support took the form of comprehensive medication management, and educational programs for managers and front line staff.
The Comprehensive Medication Management evaluates a patient's medications to ensure that they are appropriate, effective, safe, and convenient. Not only did the Wilson Pharmacy team make written medication recommendations to prescribers, but clients of the program valued the opportunity to connect with a pharmacist.
The pharmacy also provided educational training on a variety of medication and health related topics. These included psychotropic drugs, metabolic syndrome, pain management, antiretroviral drugs, and diabetes. For front-line staff the goal was to bring awareness to the role medications play in therapy, and how important of a resource the pharmacist can be. For Nursing management staff, the goal was to provide continuing education on the latest guidelines and medications used in therapy.
Collaboration in the form of pharmacy support, and medication education workshops for staff was essential to continue supporting the complex needs of clients in the CMH medication program.
The accomplishments of the Coast Mental Health and Wilson Pharmacy medication program are demonstrated through the enhanced medication experience for both clients and staff. Empirical evidence indicates that the program provides a tremendous value at both the individual and systems level.
At an individual client level, the program demonstrated that clients who previously were not engaged with their medications, now find value with connecting with a pharmacist or staff about the subject. This was demonstrated with client surveys indicating that program clients had become more interested in managing their own medications. An increasing number of clients have transitioned from Level 1 (daily witnessed ingestion), to level 3 (self-administration) medication support. Illustrating the impact of medication education, and how it can make a large difference in a client’s road to recovery.
For staff, pharmacy lead educational workshops and continued support has lead to an increase in confidence in administering medications. While front-line staff are constantly being confronted with complex issues on a daily basis, they remain confident in their ability to support their clients and administer medications. This was demonstrated by staff surveys indicating an average confidence level of over 75% in all tasks related to medication administration.
At a systems level, Coast Mental Health Medication program continues to be “accredited with exemplary standing” by Accreditation Canada. The medication error rate continues to be well below the national average. All this has been accomplished despite in an increasing number of complex patients, and a decreasing amount of resources.