MedSafer- Optimizing Prescribing for Pandemic Preparedness

Residents of Long-Term Care (LTC) are generally older than their community-dwelling counterparts, have multiple medical comorbidities, complex care needs, and often take multiple medications (on average 10 or more daily). It is clear from the first wave of the pandemic that this vulnerable population is at highest risk of severe complications from COVID-19, including death. A multi-pronged approach including comprehensive medication management is urgently needed to optimize care for people living in LTC during the pandemic and beyond. MedSafer is a Canadian-made electronic decision support tool for medication management. It is a software that cross-references a patient's medical conditions with their medications and provides a personalized report directed towards the prescriber, with a roadmap for optimizing a person's medication list. MedSafer interfaces with electronic medical records (EMRs) to make use of existing electronic healthcare data to provide individualized medication management reports directly within the EMR. There is sufficient evidence from research into medication management to justify action in typical settings, but it is unknown whether this is the case during a pandemic. This is what we aim to study. Within the context of a pandemic, medication management with MedSafer may help residents and LTC staff by 1) minimizing pill burden; 2) reducing unnecessary clinical encounters; 3) decreasing adverse drug events (ADEs); and 4) preventing ADE-associated requirements for escalation of care, such as hospital transfers. This will be a mixed-methods hybrid type 3 controlled before and after implementation study taking place over 12 months that will examine both the process and the outcomes of providing integrated MedSafer reports in the PointClickCare EMR to augment usual quarterly medication reviews. Some of the research questions we seek to answer are the following: 1. Is medication management supported by the electronic decision support tool MedSafer FEASIBLE during a pandemic? 2. What is the ACCEPTABILITY of the intervention to LTC home staff? 3. Does MedSafer augment the role of pharmacists who cannot visit the home during the outbreak (EFFECTIVENESS measured by a decrease in potentially inappropriate medications and ADEs)?