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M2030: Don't Miss Points for Injectable Medications

Published on Wed May 02, 2012 Print Friendly and PDF PDF

Tip: Safe disposal of needles or syringes counts for this item.

It's difficult to garner clinical points in a late episode of care receiving 0-13 therapy visits, but you do have the opportunity to earn them in OASIS medication item M2030. Make sure you're accurately assessing your patient's ability to manage his injectable medications with resources from the Centers for Medicare & Medicaid Services.

Consider All Injectable Medications

M2030 -- Management of Injectable Medications asks you to assess your patient's current ability to prepare and take all prescribed injectable medications reliably and safely. This includes the ability to administer the correct dose at the right time.

Your response options for M2030 are:

0 -- Able to independently take the correct medication(s) and proper dosage(s) at the correct times.

1 -- Able to take injectable medication(s) at the correct times if:

(a) individual syringes are prepared in advance by another person; OR

(b) another person develops a drug diary or chart.

2 -- Able to take medication(s) at the correct times if given reminders by another person based on the frequency of the injection.

3 -- Unable to take injectable medication unless administered by another person.

NA -- No injectable medications prescribed.

M2030 is intended to assess the patient's ability to take all injectable medications reliably and safely at all times, says consultant Pam Warmack with Clinic Connections in Ruston, La. This is not a "majority rules" item, she says. If the patient's ability varies between more than one injectable medication, you should base your answer on the medication that requires the most assistance.

Reimbursement: "Data item M2030 is a very significant clinical item on the OASIS assessment," Warmack says. This item captures points contributing to reimbursement in equations 2, 3, and 4 of the Home Health PPS model. This is particularly critical in Equation 3, which is a late episode of care receiving 0-13 therapy visits. "So many other items are blocked from points in this equation that any item that does capture points is of extreme importance," she says.

Try These Assessment Strategies

When it comes to decreasing avoidable hospitalizations, improving medication management is one of the best defenses for your patients. Make sure you're getting the most out of M2030, by assessing the following, CMS says in its online training module for the OASIS-C medication items:

  • Physical and cognitive ability to draw up the correct dose in the syringe using aseptic technique (excludes prefilled syringes from the manufacturer or pharmacy);
  • Ability to select the appropriate site;
  • Ability to inject the medication using aseptic technique;
  • Ability to dispose of the needle or syringe properly;
  • Level of assistance required; and
  • Reminder systems.

Mistake: This item excludes IV medications and infusions and medications given in the physician's office or other settings outside the home, Warmack points out. "We have had this item for several years and yet I continue to find clinicians answering this item considering injections the patient is receiving at the doctor's office or a clinic."

Don't miss: For this item, injectables include intramuscular and subcutaneous injections, Warmack says. "Some clinicians never consider subcutaneous injections when answering this item."

Actually observing your patient's ability is essential for this item. CMS suggests that you observe the patient preparing and administering his injectable medication or doing a mock preparation and administration.

Strategy: Conduct the complete medication review very early in the patient assessment, Warmack suggests. This activity will reveal a great deal about the patient early on. Many clinicians make the mistake of waiting until the very end of the assessment to review all the medications, at which point both the patient and clinician are tired, she says. "The complete medication review is a federal regulation and far too important to be dealt with so lightly."

Remember this item is intended to measure the patient's ability, not her willingness, Warmack says. "It is not about compliance but about capability." And there are several factors that contribute to a patient's capability, including physical limitations, emotional/cognitive/ behavioral impairments, sensory impairments, and environmental barriers, she says.

Score Based on Most Assistance

When answering M2030, it's important to accurately assess the level of assistance your patient needs.

You'll select response "1" if your patient is independent with administering her injection, but requires another person to prepare the doses or develop a drug diary or chart, CMS says.

Response "2" is appropriate if your patient requires reminders to administer the medication. For example, if he requires someone to call each morning with a reminder to check his blood glucose, take his insulin, and eat breakfast, you would select response "2."

You'll choose response "3" if "the patient is physically or cognitively unable to inject the ordered medication every dose, every time, and it must be administered by someone else," CMS says.

Don't miss: "Select response '3' if the physician orders nursing to administer any injection in the home," Warmack says. This is true even if it's a one-time-only injection for the episode and even if it is not due to be administered on the day of assessment, she says. "Often clinicians fail to remember this guidance when a patient is ordered to receive a flu vaccination or B12 injection."

You should also select response "3" if your patient lacks required knowledge regarding safe needle disposal on the day of assessment. Such a patient was unable to take injectable medication unless administered by another person, CMS says in OASIS Q&A Category 4 A168.3.1. If the patient could dispose of the needle/syringe safely only when given a reminder to do so, then you would select response "2."

Select response "NA" if there are no current, ongoing orders for administering an intramuscular or subcutaneous injectable medication via needle and syringe in the home at the time of discharge.

Note: To take CMS's free online training on the OASIS medication items, visit: www.cmstraining.info/data/OASISC/Module1/OASIS-C_MEDICATION_MODULE_1.htm. Read the Category 4 OASIS Q&As here: https://www.qtso.com/download/Guides/hha/CAT4_01_03_12.pdf

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