Magazine article Drug Topics

CMS to R.Ph.S: Beware of New Nursing Home Guidance

Magazine article Drug Topics

CMS to R.Ph.S: Beware of New Nursing Home Guidance

Article excerpt

A compliance guidance for nursing homes proposed by the Office of the Inspector General for the Department of Health & Human Services emphasizes the need for appropriate pharmaceutical care. The proposals, which appeared in the Federal Register earlier this year, are the first comprehensive revision of OIG's compliance guidance since 2000.

"These proposals track existing regulatory requirements and practice standards," said Claudia Schlosberg, director of policy and advocacy for the American Society of Consultant Pharmacists. "The OIG has reiterated best practices and reminded nursing homes to follow the rules. We think that is a good course to follow."

Much of the draft guidance deals with the appropriate use of psychotropic drugs, medication management, and federal kickback statutes. The OIG has found that psychotropic drugs represent two risk areas for nursing homes. One is the use of psychotropics as chemical restraints, the other is the use of unnecessary drugs.

"This guidance is OIG s way of telling nursing homes that they will be watching these areas," said consultant pharmacist Gene Memoli, president-elect of the Connecticut Society of Consultant Pharmacists. "Most of this stuff has been in place for a number of years."

In the guidance, OIG noted that facilities are specifically prohibited from using medications as a means of restraint for "purposes of discipline or convenience, and not required to treat the resident's medical symptoms."

For residents whose condition requires the use of psychotropic agents, regulations from the Centers for Medicare & Medicaid Services require that dosages be gradually reduced unless contraindicated. Residents must also receive behavioral interventions aimed at reducing medication use. "That's something that has been going on in one form or another for at least 20 years," Memoli said. "OIG is reminding nursing homes that they have to make sure it actually happens." In practice, he said, patient records must show an appropriate indication for every medication. In addition, nursing homes must monitor each use of psychotropic agents and document both the need and the monitoring.

Facilities must also document steps taken to ensure compliance. Those steps include education of staff and prescribers and ensuring that individual patient care plans are consistent with patient needs rather than the convenience of the facility or staff. …

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