Daily Editors' Notes

Nursing home theme of the summer: medication

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Tim Mullaney
Tim Mullaney

The first day of summer is not quite upon us, but it seems the season's blockbuster movie and hit song may already have been decided. And when it comes to long-term care news, I'm ready to declare that medication is the hot topic of summer 2013.

It began at the end of May, when the Centers for Medicare & Medicaid Services released a comprehensive update to survey guidelines related to off-label antipsychotic use. Next came a study showing that many common medications can trigger or slow the progress of Alzheimer's disease. Just yesterday, we shared a list of the 10 medications most frequently involved in nursing home errors.

And these are just the tip of the iceberg. Here are three other medication-related developments:

  1. In case you missed it, CMS has revised the medication pass survey guidelines in Appendix P of the State Operations Manual. Under this revision, the medication sample size has changed. Now, the facility medication error rate can be calculated using a minimum of 25 medication administration opportunities. It's acceptable for a surveyor to observe more than 25, to capture a full picture of routes, times and caregivers, the revision states.

    The change eliminates the need to extend the medication pass for another 20-25 opportunities if errors are found in the initial observations of a traditional survey. Surveyors are not supposed to stop a medication observation in the middle of administration to a resident, but should observe all medications being given, even if this pushes the total number of observations beyond 25. Surveyors will now use a new form to document medication administration observation, and CMS released this form online. Click here to access the form and the revised version of the SOM.

  2. In February, McKnight's reported on the government's efforts to tighten access to certain painkillers. One commenter wrote, “politicians ... have absolute NO medical knowledge or training,” and so “physicians are the only ones qualified to decide who does or does not get pain medications.” I could quibble that some politicians have medical training, but instead I'll focus on the second part of that comment. It seems that even doctors might not be doing a good job of deciding who does and does not get pain medications, based on recent research.

    An online survey of 200 physicians not certified to treat addiction revealed that 35% of them said they don't know very much about opioid dependence, and 66% said that low level of education could be a cause of the disorder. The American Society of Addiction Medicine defines opioid addiction as a chronic brain disorder, but 80% of the surveyed doctors said it is mainly a mental health issue.

    These survey results are troubling, and indicate that people addicted to opioids may not be getting the proper treatment, according to Mark L. Kraus, M.D., assistant clinical professor of medicine at the Yale University School of Medicine. Addicted individuals should be referred to addiction specialists who can devise an appropriate care plan, Kraus said, and caregivers should evaluate whether they are stigmatizing these patients.

    Click here
    to access results of the survey, which was conducted online by Harris Interactive and commissioned by Reckitt Benckiser Pharmaceuticals Inc.

  3. Painkillers top the list of drugs most commonly involved in nursing home errors. If you're a provider reviewing painkiller use, you may want to pay special attention to which residents are on aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Another recent study shows doctors may be commonly prescribing NSAIDs inappropriately.

    The study, presented at the European League Against Rheumatism conference in Madrid, tracked more than 10,000 patients at a primary care practice in Ireland, and found that more than half of heart patients were prescribed NSAIDs for a month or longer — despite the fact that NSAIDs increase the risk of death among cardiac patients.

    Although prescribing practices may be different on this side of the pond, the study suggests long-term caregivers may want to give a second look to residents being transferred into a facility after a heart attack or other cardiovascular issue. With readmissions penalties looming on the horizon, the last thing providers need is a hospitalization caused by an easily avoided NSAID prescription — to say nothing about the benefit to residents themselves, if they're taken off an inappropriate drug.

"The Summer of Nursing Home Medication Awareness" may not have the same ring as "The Summer of Love" or be as funny as "The Summer of George," but if residents are better off come the fall, it will be a summer worth remembering.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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