The most obvious example of a situation that could include an Unnecessary Drug is when a patient is admitted or a new medication is started and a proper diagnosis is not noted in the medical record. We encourage you to add all diagnoses to one central list, even if the diagnosis can be found in other parts of the medical record. Excessive dose happens more frequently than we realize. Although medication references list maximum daily dosages, those maximums are often different for the geriatric population and sometimes also differ based on the condition being treated. It is important to ensure...

A lot has changed in the diagnosis and treatment of Clostridium Difficile Infection (CDI) since the Infectious Disease Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) last published guidelines in 2010. The new guidelines recommend the development of an antibiotic stewardship program, which should focus on reducing the frequency and duration of the use of high-risk antibiotics. Specifically, restriction of fluoroquinolones, clindamycin, and cephalosporins (except for surgical antibiotic prophylaxis) should be considered. Although probiotics are commonly seen during the treatment of CDI, the current guidelines state that there is insufficient data to support this practice...

There were two important changes that took place when Phase Two of the CMS “Mega Rule” became effective on November 28, 2017: 1) limiting PRN psychotropic medication orders to 14 days and 2) implementing an Infection Prevention and Control Program (IPCP) that includes an Antibiotic Stewardship Program. Last month we discussed specific limits on PRN psychotropics. This month we will discuss antibiotic stewardship and what you must do to be compliant. CMS requires facilities to establish an infection prevention and control program (IPCP) that must include, at a minimum, an antibiotic stewardship program. The goal of the program is to...

At this point everyone has heard of the so-called CMS “Mega Rule” or the nursing home Requirements for Participation, and the resulting changes. On September 28, 2016, CMS issued the Mega Rule with a three-phase implementation. Phase 1 became effective on November 28, 2016. Phase 2 became effective on November 28, 2017, and Phase 3 will become effective on November 28, 2019. During Phase 1 we talked about the need for the pharmacist to perform a drug regimen review (DRR) for each resident at least once a month and for a report to be provided to the attending physician, Director...