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News: Changes to Domiciliary Medication Management Review (DMMR)
4 June 2018
How can nurses assist in patient’s Domiciliary Medication Management Review (DMMR), also known as a Home Medicines Review (HMR)?
If nurses are of the belief a person would benefit from a medicines review then they can speak to the relevant medical practitioner who is the prescriber or encourage patients and their carers/spouses or family to enquire about this valuable service[i].
Nurses frequently encounter and identify patients who would benefit from a medicines management review when performing health assessments, care planning and other nursing activities. Nurses are then able to coordinate arrangements for follow up discussions with the patient’s general practitioner.
Why encourage a home medicines review?
With medicines use increasing and polypharmacy common in older people with multiple co-morbidities we now have a situation where many more of hospital admissions of older people are drug-related compared with younger adults.
There is now overwhelming evidence that older people are at increased risk of medication-related problems and adverse medication events.[ii]
Reasons for these are:
- Multiple co-morbidities requiring multiple medicines (polypharmacy)
- Failure to receive indicated medicine
- Under-prescribing, inappropriate or unnecessary medicines
- Multiple prescribers
- Suboptimal monitoring and lack of medicines review (Home Medicines Review)
- Drug interactions
- Lack of patient information, learning difficulties and low health literacy (includes other languages)
- Intentional and non-intentional levels of adherence to medicines regime
- Dosage or timing errors
- Cognitive decline
- Physical, swallowing or dexterity difficulties
- Altered physiology with ageing (pharmacokinetics)
- Inability to read standard pharmacy labels
- Difficulty opening containers
- Inaccurate packing of dose administration aids
- Re-packing – usually into un-labelled or incorrectly labelled containers
- Inability to split tablets especially un-scored tablets
- Lack of carer support.
How are medicines reviews undertaken and billed?
Medicines reviews are a cornerstone method to improve a person’s safe use of medicines.[iii] Whilst reviews are sometimes undertaken as part of normal care, if a patient consents, they can be referred for a DMMR, which is conducted by accredited pharmacists. These reviews are subject to guidelines on the MBS items for medication management.
An overview of requirements are outlined below:
- The time the patient is identified as needing a review and consent obtained
- Referring the patient to their preferred community pharmacy or an accredited pharmacist
- Provision of relevant information (diagnosis, test results, medication history, current prescribed medications)
- Pharmacist visiting the patient to review their medications
- Pharmacist to discuss the results of the DMMR with the GP, including suggested management strategies
- Following discussion with the patient, a written plan, identifying medication management goals and the proposed medication regimen for the patient must be written
- Discussion and agreement with the patient
- A copy of this plan then needs to be provided to a community pharmacy chosen by the patient
The benefit is not claimable until all the above components have been completed, i.e. after the second patient consultation.[iv]
Further information and links are provided below:
Overall, nurses play a really important role in early identification of those in need for a DMMR which may assist in early intervention of those at risk of complications due to (often inadvertent) medication mismanagement.
[i] Medicare Benefits Schedule – Item 900 – Associated notes. http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&qt=ItemID&q=900
[ii] Elliott RA & Booth JC. Problems with medicine use in older Australians: a review of recent literature. Journal of Pharmacy Practice and Research. 2014 : 44: 258-271.
[iii] Roughhead L, Semple S & Rosenfeld E. Literature review: Medication safety in Australia. Australian Commission on Safety and Quality in Health Care. (ACSQHC) .August. 2013
[iv] Department of Health. Medication management reviews. http://www.health.gov.au , http://www.health.gov.au/internet/main/publishing.nsf/Content/medication_management_reviews.htm
This article was featured in APNA Connect – 4 June 2018.