CMS Manual System - Louisiana Department of Health and Hospitals

or her highest practicable level of well-being. The potential exists for greater harm to occur if
interventions are not provided. Examples include, but are not limited to:
The facility failed to respond to the pharmacist’s notification that the resident was
not receiving all the medications ordered; however, there was no change in the
resident condition.
The pharmacist‘s MRR failed to identify and report a resident who is receiving multiple
antihypertensive medications, but is not being monitored for postural hypotension, and
who complains of lightheadedness especially while upright.
The pharmacist‘s MRR failed to identify and report risks of hyperkalemia in a resident
who has impaired renal function and is receiving an ACE inhibitor and potassium
supplements.
The pharmacist‘s MRR failed to evaluate and report on the potential adverse
consequences of a medication known to cause anorexia for a resident with a recently
decreased appetite, who had not yet experienced a significant unplanned weight loss.
Findings of noncompliance at Severity Level 2 at tag(s) F309, F329, or F332, F333 that
show evidence of process failures for conducting the MRR.
NOTE: If Severity Level 2 (no actual harm with potential for more than minimal harm
that is not immediate jeopardy) has been ruled out based upon the evidence, then
evaluate as to whether Severity Level 1 (no actual harm with the potential for
minimal harm) exists.
Severity Level 1 Considerations: No Actual Harm with Potential for Minimal Harm
Level 1 indicates noncompliance that resulted in no harm to the resident, and the potential for no
more than minimal harm. Examples may include, but are not limited to:
The pharmacist conducted the medication review, identified an irregularity that has not
resulted in a negative outcome and is of minimal consequence (such as a multi-vitamin
not being given as ordered) and reported to the director of nursing and attending
physician, but neither of them acted upon the report.
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F431
(Rev. 22, Issued: 12-15-06, Effective/Implementation: 12-18-06)
§483.60(b) Service Consultation. The facility must employ or obtain the services of a
licensed pharmacist who--
(2) Establishes a system of records of receipt and disposition of all controlled drugs in
sufficient detail to enable an accurate reconciliation; and