A long time ago in a galaxy far, far away (think November 2016), we in PALTC were faced with the challenge of implementing the three-phased rollout of the “CMS MegaRule.”
Spooky, right?
Even spookier, on Oct. 1, 2018, the MDS requirements were updated to include N2001 (drug regimen review on admission) and N2003 (medication follow-up on admission) which requires that potentially clinically significant medication issues (PCSMI), once identified, be addressed by midnight of the next calendar day!
In light of the recent events beginning in March 2020 (cough – global pandemic – cough), how is your facility continuing to handle these requirements? If you’re not currently utilizing your pharmacist in admissions, you should be.
Like a well-oiled machine, you’re used to getting your consultant pharmacist’s monthly reports containing recommendations for your residents. What may not be commonplace is pharmacist review and recommendations for new admissions since the October 2018 requirements do not specifically name which provider(s) should/must be involved.
A preliminary assessment done by the American Society of Consultant Pharmacists’ (ASCP) Quality Improvement Project Committee found that when a consultant pharmacist reviewed the resident’s admission orders within 72 hours of admission, medication-related problems (MRPs) resulting in recommendations were identified in 40% of residents at a rate 2.5 times higher compared to those identified during the monthly review process. These recommendations were most related to psychotropic medications (40%) and stop date clarifications (20%).
Think about the workflow breakdown that typically occurs during an admission process: the resident’s nurse confirms the admission orders with the physician (first opportunity for identification of MRPs), then once confirmed, the nurse enters the medication orders into the EHR (second opportunity for identification MRPs). The pharmacist performing the admission drug regimen review within 72 hours after this standard process is completed still found MRPs in 40% of residents – illustrating a gap in care that must be closed.
Having a pharmacist in admission reviews can smooth the workflow and reduce the number of MRPs your residents experience during their stay. Reduced MRPs mean an overall reduced risk of hospital readmission, period. If your facility is not currently utilizing pharmacist services for admission reviews, simply contact your pharmacy provider or consultant pharmacist to discuss implementation.
Kaylee Mehlman, PharmD, RPh, BCGP, FASCP, is a member of the American Society of Consultant Pharmacists’ Quality Improvement Project Committee.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
