CMS Manual System - Louisiana Department of Health and Hospitals

criteria for evaluating the benefit(s) of the medication, and recognizing and evaluating
adverse consequences. Monitoring parameters are based on the resident‘s condition, the
pharmacologic properties of the medication being used and its associated risks,
individualized therapeutic goals, and the potential for clinically significant adverse
consequences.
Adverse consequences related to medications are common enough to warrant serious
attention and close monitoring. For example, a study reported that 338 (42%) of 815
adverse drug events were judged preventable, and that common omissions included
inadequate monitoring and either lack of response or a delayed response to signs,
symptoms, or laboratory evidence of medication toxicity. 55
Sources of information to facilitate defining the monitoring criteria or parameters may
include cautions, warnings, and identified adverse consequences from:
Manufacturers‘ package inserts and black-box warnings;
Facility policies and procedures;
Pharmacists;
Clinical practice guidelines or clinical standards of practice;
Medication references; and
Clinical studies or evidence-based review articles that are published in medical
and/or pharmacy journals.
Monitoring of the resident‘s response to any medication(s) is essential to evaluate the
ongoing benefits as well as risks of various medications. It is important, for example, to
monitor the effectiveness of medications used to address behavioral symptoms (e.g.,
behavioral monitoring) or to treat hypertension (e.g., periodic pulse and blood pressure).
Monitoring for adverse consequences involves ongoing vigilance and may periodically
involve objective evaluation (e.g., assessing vital signs may be indicated if a medication
is known to affect blood pressure, pulse rate and rhythm, or temperature). Using
quantitative and qualitative monitoring parameters facilitates consistent and objective
collection of information by the facility.
Examples of tools that may be used by facility staff, practitioners, or consultants to
determine baseline status as well as to monitor for effectiveness and potential adverse
consequences may include, but are not limited to the following:
Common
Conditions/
Symptoms
Examples
of Tools
Potential
Applications
Source/Reference