CMS Manual System - Louisiana Department of Health and Hospitals

Advance Directives – A resident may have written or verbal directions related to
treatment choices (or a decision has been made by the resident‘s surrogate or
representative) in accordance with state law. An advance directive is a means for the
resident to communicate his or her wishes, which may include withdrawing or
withholding medications. Whether or not a resident has an advanced directive, the
facility is responsible for giving treatment, support, and other care that is consistent with
the resident‘s condition and applicable care instructions.
NOTE: Choosing not to be resuscitated (reflected in a ―Do Not Resuscitate‖ (DNR)
order) indicates that the resident should not be resuscitated if respirations
and/or cardiac function cease. A DNR order by itself does not indicate that
the resident has declined other appropriate treatment and services.
Under these regulations, medication management includes consideration of:
I. Indications for use of medication (including initiation or continued use of
antipsychotic medication);
II. Monitoring for efficacy and adverse consequences;
III. Dose (including duplicate therapy);
IV. Duration;
V. Tapering of a medication dose/gradual dose reduction for antipsychotic
medications; and
VI. Prevention, identification, and response to adverse consequences.
I. Indications for Use of Medication (including Initiation or Continued Use of
an Antipsychotic Medication)
An evaluation of the resident helps to identify his/her needs, comorbid conditions, and
prognosis to determine factors (including medications and new or worsening medical
conditions) that are affecting signs, symptoms, and test results. This evaluation process is
important when making initial medication/intervention selections and when deciding
whether to modify or discontinue a current medication intervention. Regarding ―as
needed‖ (PRN) medications, it is important to evaluate and document the indication(s),
specific circumstance(s) for use, and the desired frequency of administration. As part of
the evaluation, gathering and analyzing information helps define clinical indications and
provide baseline data for subsequent monitoring. The evaluation also clarifies:
Whether other causes for the symptoms (including behavioral distress that could
mimic a psychiatric disorder) have been ruled out;