Ask the care expert: Can we limit med passes to three times a day?
Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA
This answer is directly from Centers for Medicare & Medicaid Services: “We have no regulation that requires medications to be ordered for specific clock times. Our surveyors check to see if staff give medications according to the order. If an order is for a.m., and the facility policy is to give a.m. at a certain clock hour, that is what we would check.
“We encourage nursing homes to work with their physicians to liberalize the ordering policies so that medications that were given by policy at certain clock times could be redone to ‘on awakening,' ‘before lunch,' etc. This could accommodate residents who arise and/or eat at different times of their choice.”
A satellite broadcast was done by Karen Schoeneman, Technical Director, CMS Divisions of Nursing Homes, a few years ago called “Clinical Case Studies in Culture Change.” In it, there is a physician discussing how he liberalized medication-ordering policies to do just that. This broadcast is in the list of archived broadcasts up on the CMS surveyor training website. It is available to everyone. If you are interested in the presentation, you can go to this website: http://surveyortraining.cms.hhs.gov/pubs/SurveyorTraining.aspx . You will need to create a user name and password first.
The physician in that show also discussed how he reviewed medications he had been prescribing three or four times a day to determine whether there were other suitable medications that were needed perhaps only one or two times per day, in order to minimize waking residents to give them their medications.