We actually do have a list of high risk medications that is published by our hosptial as part of the care planning and protocols that are in place as a written policy. Interestingly, drugs that you might not consider "high risk" are on here, including insulin and synthroid. However, there's more to determining the patient risk than noting the prescription of a high risk drug. You also must look at the route of delivery, whether or not the dosage is at a therapeutic level, how much ongoing monitoring is involved in getting (and keeping) it at therepeutic level, adverse effects, contraindications, and how long the patient has been on the drug...and so forth. Asking the providers to document all that information is my biggest challenge!
If only it was straightforward.....
One example I give my providers who want to get high MDM for a patient on Coumadin, is that they have to show me that they are doing 'intensive monitoring' of this drug. So if the patient has been successfully prescribed Coumadin (or Warfarin) for a year, and only goes for PT-INR every month or two, and remains on the same dose...well, that's not intensive monitoring, in my opinion. So I'd give only moderate risk here, and probably only low MDM, if there's only the stable condition as a single diagnosis.
Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
Dover, NH 03820
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