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GENERAL OBLIGATION: Regularly review patient
medication regimens and adjust or discontinue as
necessary.
NURSING HOME REGULATION
KEY POINTS FROM CMS INTERPRETIVE GUIDANCE
(Medicare State Operations Manual, Appendix PP; CMS Survey &
Certification Letter 12-48-NH)
42 C.F.R. § 483.25 Quality of Care
Each resident must receive and the facility must provide the
necessary care and services to attain or maintain the highest
practicable physical, mental, and psychosocial well-being, in
accordance with the comprehensive assessment and plan of care.
F309 (483.25) – End of Life Care
For residents nearing end of life, nursing homes have specific
guidelines under the "Medications/Drugs" section that
require them to "review the continued need for any routine
administration of medication and adjust or discontinue, as
appropriate."
This section also emphasizes that the "use of medications
be consistent with the goals for comfort, control of symptoms, and
for the individual's desired level of alertness."
These standards apply regardless of whether the patient is on
hospice, and requires the nursing home to "review and revise
the care plan as necessary to address the resident's situation,
including expectations and management of specific symptoms and
concerns."
For residents receiving hospice care, the "nursing
facility coordinates care planning with the hospice."
42 C.F.R. § 483.25(l) Unnecessary
Drugs
Each resident's drug regimen must be free from unnecessary
drugs. An unnecessary drug is any drug when used: (i) in excessive
dose (including duplicate drug therapy); or (ii) for excessive
duration; or (iii) without adequate monitoring; or (iv) without
adequate indications for its use; or (v) in the presence of adverse
consequences which indicate the dose should be reduced or
discontinued; or (vi) any combinations of the reasons above.
F329 (483.25(l)) – Unnecessary Drugs
The guidelines note that the "indications for initiating,
withdrawing, or withholding medication(s), as well as the use of
non-pharmacological approaches, are determined by assessing the
resident's underlying condition, current signs and symptoms,
and preferences and goals for treatment. This includes, where
possible, the identification of the underlying cause(s), since a
diagnosis alone may not warrant treatment with
medication."
When evaluating residents' drug/medication regimen, the
reviewer will consider and recognize the need for end of life or
palliative care, if applicable.
Nursing homes must collaborate with the prescriber and
"utilize[] only those medications in appropriate doses for the
appropriate duration, which are clinically necessary to treat the
resident's assessed conditions."
42 C.F.R. § 483.60(c) Drug Regimen
Review
The drug regimen of each resident must be reviewed at least once
a month by a licensed pharmacist. The pharmacist must report any
irregularities to the attending physician and the director of
nursing, and these reports must be acted upon.
F428 (483.60(c)) – Drug Regimen
Review
Monitoring residents' drug/medication regimens includes the
"ongoing collection and analysis of information and comparison
to baseline data in order to . . . support decisions about
modifying, discontinuing, or continuing interventions."
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