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OASIS Alert

Compliance:

Improve Medication Assessment And Management With These Tips

Published on Wed Aug 17, 2005 Print Friendly and PDF PDF

Don't let lack of compliance lead you astray.

You may have to be a detective to find out what meds your patient is taking this visit. Patients won't necessarily tell you - even if you ask.

Medication review is an important part of any patient assessment, says Vienna, VA-based home care senior consultant Mary Narayan with Visiting Nurse Service Network.

And medication review is required by the Home Health Agency Conditions of Participation, Los Angeles-based home care consulting pharmacist Dennee Frey reminds providers.

Herbal Supplements Are Often Missed

Whether a nurse or therapist makes the visit, Narayan recommends the medication assessment include these questions, at a minimum:
 

  • Have there been any changes in medications since the last visit?
     
  • Is the patient having any trouble taking the medications as ordered? 
     
  • Is the patient achieving a therapeutic effect from the medications in as far as the clinician can tell?
     
  • Is the patient experiencing any symptoms that could be side/adverse effects of the medication?

    Tip: Patients may not think to tell you about the herbal supplements or over-the-counter medicines they take - unless you ask, Narayan reminds clinicians. Also, try to determine if there is a difference between what is on the medication record and what the patient is actually taking, she adds. There are many reasons a patient may not be taking the medication as ordered, such as finances, cognitive issues, side effects or inability to get someone to pick up a refill, experts say.

    Don't Just Review - Take Action

    Consider yourself on the front lines of the effort to promote patient safety, Frey suggests 

    Best bet: Having a standardized procedure or process - perhaps built around accreditation standards like the Joint Commission on Accreditation of Healthcare Organizations or the Community Health Accreditation Program - leads to better and more consistent medication review by clinical staff, Frey observes. A standardized process also leads to additional focus on outcomes, especially patient safety, she tells Eli.

    Frey suggests clinicians: 

  • Take time to do a thorough medication inventory;
     
  • Continue with an assessment of the drug regimen;
     
  • Alert the physician to potential problems; and
     
  • Document their activities.

    Strategy: Consider using computerized screens to pick up therapeutic duplications and high-risk meds. And focus on training to increase staff competency in this area, Frey recommends.

    Understand M0780 Nuances

    When assessing the patient's management of oral medications, read M0780 (Man-agement of Oral Medications) carefully. It does not ask whether the patient complies with the medication regimen. It asks whether the patient is able to take the prescribed medications reliably and safely, according to the Centers for Medicare & Medicaid Services.

    Other M0780 assessment tips from CMS include: 

  • If the patient's ability varies, choose the response that describes the patient's ability more than half the time. When determining this, consider the number of times the patient takes each of the meds daily.
     
  • Don't include injectable or intrave-nous meds.
     
  • Don't include meds administered via gastrostomy tube.
     
  • Do observe the patient opening meds and reading labels and ask questions about how much she takes and when.
     
  • Don't consider obtaining the meds as part of this question. 

    Note: If your agency is addressing medication management improvement, go to www.homemeds.org/AoA_site/home.htm for a model program and tools. For more information on medication issues in home care, see the Journal of Home Health Services, Aug. 2005.

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