Module 3: The Drug Regimen Review - College of Pharmacy ...

More documents

Recommendations

Info

Bloating Bowel motility, decreased Constipation Ileus, paralytic/adynamic Nausea or vomiting Swallowing difficulty with dry mouth 44 Distress, excitement, nervousness Attention, impaired Cognitive decline Confusion/disorientation Halucinations Memory loss Restlessness or irritability Delirium Dizziness Drowsiness Fever Headache Heart rate, increases Lethargy, fatigue Mucous membrane dryness: mouth nose Muscle weakness, severe Speech, slurring Skin, changes Vision impairment, changes in acuity Dryness Sweating, decreased Flushing Blurring Urinary retention or difficulty Glaucoma, worsening EXCERPTS FROM F428 §483.60(c) Drug Regimen Review (1) The drug regimen of each resident must be reviewed at least once a month by a licensed pharmacist. (2) The pharmacist must report any irregularities to the attending physician, and the director of nursing, and these reports must be acted upon. INTENT (F428) 42 CFR 483.60(c)(1)(2) Medication Regimen Review The intent of this requirement is that the facility maintains the resident’s highest practicable level of functioning and prevents or minimizes adverse consequences related to medication therapy to the extent possible, by providing: • A licensed pharmacist’s review of each resident’s regimen of medications at least monthly; or o A more frequent review of the regimen depending upon the resident’s condition and the risks or adverse consequences related to current medication(s); • The identification and reporting of irregularities to the attending physician and the director of nursing; and • Action taken in response to the irregularities identified. NOTE: Although the regulatory language refers to “drugs,” the guidance in this document generally will refer to “medications,” except in those situations where the term “drug” has become part of an established pharmaceutical term (e.g., adverse drug event, and adverse drug reaction or consequence). For purposes of this guidance, references to “the pharmacist” mean the licensed pharmacist, whether employed directly by the facility or through arrangement. OVERVIEW Many nursing home residents require multiple medications to address their conditions, leading to complex medication regimens. Medications are used for their therapeutic benefits in diagnosing, managing, and treating acute and/or chronic conditions, for maintaining and/or improving a resident’s functional status, and for improving or sustaining the resident’s quality of life. The nursing home population may be quite diverse and may include geriatric residents as well as individuals of any age with
special needs, such as those who are immunocompromised or who have end stage renal disease or spinal cord or closed head injuries. Regardless, this population has been identified as being at high risk for adverse consequences related to medications. Some adverse consequences may mimic symptoms of chronic conditions, the aging process, or a newly emerging condition. Transitions in care such as a move from home or hospital to the nursing home, or vice versa, increases the risk of medication-related issues. Medications may be added, discontinued, omitted, or changed. It is important, therefore, to review the medications. Currently, safeguards to help identify medication issues include: • The physician providing and reviewing the orders and total program of care on admission and the prescriber reviewing at each visit; • The nurse reviewing medications when transmitting the orders to the pharmacy and/or prior to administering medications; • The interdisciplinary team reviewing the medications as part of the comprehensive assessment for the Resident Assessment Instrument (RAI) and/or care plan; • The pharmacist reviewing the prescriptions prior to dispensing; and • The pharmacist performing the medication regimen review at least monthly. During the MRR, the pharmacist applies his/her understanding of medications and related cautions, actions and interactions as well as current medication advisories and information. The pharmacist provides consultation to the facility and the attending physician(s) regarding the medication regimen and is an important member of the interdisciplinary team. Regulations prohibit the pharmacist from delegating the medication regimen reviews to ancillary staff. This guidance is not intended to imply that all adverse consequences related to medications are preventable, but rather to specify that a system exists to assure that medication usage is evaluated on an ongoing basis, that risks and problems are identified and acted upon, and that medication-related problems are considered when the resident has a change in condition. This guidance will discuss the following aspects of the facility’s MRR component of the pharmaceutical services systems: • A pharmacist’s review of the resident’s medication regimen to identify and report irregularities; and • Acting upon identified irregularities in order to minimize or prevent adverse consequences, to the extent possible. NOTE: The surveyor’s review of medication use is not intended to constitute the practice of medicine. However, surveyors are expected to investigate the basis for decisions and interventions affecting residents. MEDICATION REGIMEN REVIEW (MRR) The MRR is an important component of the overall management and monitoring of a resident’s medication regimen. The pharmacist must review each resident’s medication regimen at least once a month in order to identify irregularities; and to identify clinically significant risks and/or adverse consequences resulting from or associated with medications. It may be necessary for the pharmacist to conduct the MRR more frequently, for example weekly, depending on the resident’s condition and the risks for adverse consequences related to current medications. Generally, MRRs are conducted in the facility because important information about indications for use, potential medication irregularities or adverse consequences (such as symptoms of tardive dyskinesia, dizziness, anorexia, or falls) may be attainable only by talking to the staff, reviewing the medical record, and observing and speaking with the resident. However, electronic health and medication records and other 45
Page 1 and 2: THE FEDERAL GUIDELINES AND LIABILIT
Page 3 and 4: they feel confident that they did n
Page 5 and 6: • Individualizing toileting sched
Page 7 and 8: I. Indications for use of medicatio
Page 9 and 10: for monitoring specific medications
Page 11 and 12: Common Examples Potential Source/Re
Page 13 and 14: Monitoring involves three aspects:
Page 15 and 16: Tapering may be indicated when the
Page 17 and 18: The risk for adverse consequences i
Page 19 and 20: elease • oxycodone, sustained rel
Page 21 and 22: gabapentin lamotrigine levetiraceta
Page 23 and 24: Tricyclic antidepressants (TCAs), e
Page 25 and 26: Antiparkinson Medications All class
Page 27 and 28: o Enduring Psychiatric Conditions A
Page 29 and 30: Anxiolytics All Anxiolytics Benzodi
Page 31 and 32: All antihypertensives Alpha blocker
Page 33 and 34: Diuretics, e.g., bumetanide ethycri
Page 35 and 36: Antihistamine H-1 blockers, e.g., c
Page 37 and 38: Hematinics Erythropoiesis stimulant
Page 39 and 40: had a previous stroke or have evide
Page 41 and 42: Barbiturates, e.g., amobarbital but
Page 43: MEDICATIONS WITH SIGNIFICANT ANTICH
Page 47 and 48: o Headaches, muscle pain, generaliz
Page 49 and 50: The pharmacist’s findings are con
Page 51 and 52: ationale for a treatment regimen an
Page 53 and 54: “Duration” is the total length
Page 55 and 56: 15. Review lab values to identify s
Page 57 and 58: The most challenging aspect of the
Page 59 and 60: administration. While the MRR repre
Page 61 and 62: E. Creating a plan of action 1. I w

Module 3: The Drug Regimen Review - College of Pharmacy ...

Create successful ePaper yourself

Delete template?

Save as template?