Spurred by concerns about the distribution of certain medicines in nursing homes, the American Society of Consultant Pharmacists (ASCP) has called for changes to a manual that provides guidance to Medicare and Medicaid surveyors.

The ASCP said that some of the current requirements to surveyors in the State Operations Manual regarding gradual dose reduction and the use of psychotherapeutic medications could jeopardize the health of nursing home residents. Surveyors work with state health departments and use the manual in determining whether nursing facilities are compliant with CMS regulations.

Specifically, ASCP noted that gradual dose reduction should not be required for all psychotherapeutic medications, and that there should be consistent time frames for dosage reduction attempts for psychotherapeutic medications. In addition, patients with seizures or bipolar disorder could be harmed when subjected to gradual dose reductions of anticonvulsants.

ASCP also commented on issues regarding the medication regimen review (MRR). It recommended that the facility-wide recommendations be housed in an established, consistent location.