CMS Manual System - Louisiana Department of Health and Hospitals

necessarily indicate a need for dose adjustments, but may warrant further evaluation of a
dose or the medication regimen.
The route of administration influences a medication‘s absorption and ultimately the dose
received. Examples of factors that can affect the absorption of medications delivered by
transdermal patches include skin temperature and moisture, and the integrity of the patch.
Similarly, the flow rate of intravenous solutions affects the amount received at a given
time.
Duplicate therapy is generally not indicated, unless current clinical standards of practice
and documented clinical rationale confirm the benefits of multiple medications from the
same class or with similar therapeutic effects. Some examples of potentially problematic
duplicate therapy include:
Use of more than one product containing the same medication can lead to
excessive doses of a medication, such as concomitant use of
acetaminophen/hydrocodone and acetaminophen, which may increase the risk of
acetaminophen toxicity;
Use of multiple laxatives to improve or maintain bowel movements, which may
lead to abdominal pain or diarrhea;
Concomitant use of multiple benzodiazepines such as lorazepam for anxiety and
temazepam for sleep, which may increase fall risk; or
Use of medications from different therapeutic categories that have similar effects
or properties, such as multiple medications with anticholinergic effects (e.g.,
oxybutynin and diphenhydramine), which may increase the risk of delirium or
excessive sedation.
Documentation is necessary to clarify the rationale for and benefits of duplicate therapy
and the approach to monitoring for benefits and adverse consequences. This
documentation may be found in various areas of the resident‘s clinical record.
IV. Duration
Many conditions require treatment for extended periods, while others may resolve and no
longer require medication therapy. For example:
Acute conditions such as cough and cold symptoms, upper respiratory condition,
nausea and/or vomiting, acute pain, psychiatric or behavioral symptoms;
Proton pump inhibitors (PPIs)/H2 blockers used for prophylaxis during the acute
phase of a medical illness should be tapered and possibly discontinued after the
acute phase of the illness has resolved, unless there is a valid clinical indication
for prolonged use.