for Skilled Nursing Facilities
The intent of this section is to provide resources that will be useful for practitioners working primarily in Skilled Nursing Facilities (SNFs) and/or Nursing Homes.
The following "Clinical Alerts" have been compiled by the Maryland Department of Health and Mental Hygiene Office of Health Care Quality (OHCQ). These alerts represent issues related to medication management and safety that may impact skilled nursing facilities in the state of Maryland.
- It Takes a Village: Anticipating and Managing Medication Side Effects [PDF]
- Transdermal Fentanyl Safety [PDF]
- WARFARIN [PDF]
- Potassium: Still a Very Dangerous Drug [PDF]
- Medication reconciliation error between a hospital and long term care facility [PDF]
- IV Promethazine Injuries [PDF]
Behavioral Health and Antipsychotic Medication Use
- Nursing Home Initiative on Behavioral Health and Antipsychotic Medication Webinar
The Centers of Medicare and Medicaid Services (CMS) developed this webinar as part of a national action plan to improve the behavioral health and to reduce the unnecessary antipsychotic medication use of residents in skilled nursing facilities. This webinar presents relevant cases that are discussed by an interdisciplinary team.
- Additional Resources Regarding the CMS Initiative on Behavioral Health and Antipsychotic Medication
The Advancing Excellence in America’s Nursing Homes Campaign announces the launch of CMS's initiative on reducing the use of antispychotic medications in nursing home residents. This document includes a list of additional resources addressing behavioral health and antipsychotic medication use.
- AHCA Applauds CMS Initiative on Reducing Antipsychotics
The American Health Care Association (AHCA) supports CMS's initiative to reduce the unnecessary use of antipsychotic medications in skilled nursing facilities.
- ASCP Resources on Antipsychotic Medication Use
The American Society of Consultant Pharmacists (ASCP) has compiled a list of resources on both pharmacologic and non-pharmacologic approaches to treat behavioral and psychological symptoms associated with dementia (BPSD).
National Nursing Home Quality Care Initiative
- Delmarva Foundation for Medical Care Collaborative Resources
The Delmarva Foundation for Medical Care (DFMC) of Maryland strives to improve health services and programs. DFMC has partnered with the Centers of Medicare and Medicaid Services in developing and providing resources that aim to "ensure that every nursing home resident receives the highest quality of care." Resources provided on this page include "Reducing Pressure Ulcers" from the Maryland QIO, "CMS Dementia Care Resources and Tools" from the Advancing Excellence in America’s Nursing Homes, "Off-Label Use of Atypical Antipsychotics: An Update Effective Health Care Program" from the AHRQ Effective Care Program, and much more! Click here to learn more about the National Nursing Home Quality Care Initiative.
The following sections highlight regulations (F tags) relevant to skilled nursing facilities. There is an excerpt of the regulations quoted below with identified public resources to aid you in your practice setting.
F329 Unnecessary Medications
Each resident’s drug regimen must be free from unnecessary drugs. An unnecessary drug is any drug when used:
- In excessive dose (including duplicate therapy); or
- For excessive duration; or
- Without adequate monitoring; or
- Without adequate indications for its use; or
- In the presence of adverse consequences which indicate the dose should be reduced or discontinued; or
- Any combinations of the reasons above.
- CMS Manual System [PDF], F329, pgs. 347-428
F428 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.
- CMS Manual System [PDF], F428, pgs. 508-524
- Unnecessary Medications and Pharmacy Services: State Surveyor Training Materials
The American Medical Directors Association (AMDA) has compiled a list of resources from the Centers of Medicare and Medicaid Services (CMS) that are to be used as training materials for state surveyors. This page hosts Guidance Training PowerPoint presentations on Storage, Labeling and Controlled Medications, Medication Regimen Review, and Pharmacy Services. It provides links to the CMS State Operations Manual Appendix P, and the revisions to the following regulations: Unnecessary Drugs, Pharmacy Services, Drug Regimen Review, and Labeling of Drugs and Biologics.
- Nursing Home Journal Volume IV Unnecessary Medications Video
This CMS broadcast was designed as an educational video for state and federal surveyors. It is 2 hours and 30 minutes in length, and provides an introduction to the 2006 revisions of the Unnecessary Drugs and Pharmacy Services regulations.
- Medication Regimen Review: CMS Instructor’s Manual [PDF]
This presentation was produced by the Centers of Medicare and Medicaid Services (CMS). This guidance training includes a slide show presentation, notes for the instructor, and the general message on each slide. Some of the goals of this training presentation include describing the MRR regulation, identifying compliance with the regulation and issues that lead to an F428 investigation, and categorizing the severity of non-compliance issues.
The Institute for Safe Medication Practices is a non-profit organization that advocates for safe medication practices through education. Some tools and resources of most interest on this website include the "Do Not Crush" List, Guidelines for Timely Administration of Medications, and Improving Medication Safety with Anticoagulant Therapy.