In Part 1 of this blog series on ACHC’s top home health agency survey deficiencies, we looked at the Plan of Care. In the second installment of this weighty topic, let’s discuss medications. CMS – and by extension, accrediting organizations – require a comprehensive assessment and regulations detail the aspects of this evaluation. A review of medications is a critical component. During the assessment and on a regular basis, agencies must review all of the medications, prescription and non-prescription, the patient is taking. The review begins with making sure all the medications (as defined above) are listed on a medication profile, including the correct medication name, dose and frequency. Next, the registered nurse must assess:
- Potential adverse effects and drug reactions, including ineffective drug therapy;
- Significant side effects;
- Toxic effects;
- Drug and/or food allergies, in addition to allergic reactions;
- Immediate desired effects;
- Unusual and unexpected effects including those which may rapidly endanger the patient’s life or well-being;
- Significant drug interactions;
- Duplicate drug therapy;
- Noncompliance with drug therapy;
- Changes in the patient’s condition that contraindicate continued administration of the medication.
For therapy-only cases, the therapist can compile a list all of the medications and forward the listing to the RN to review. As with all things medical, documentation is the key so the therapist must, of course, date the medication listing and sign it with his/her credentials and make a notation that the listing was forwarded to a named individual. The reviewing nurse will do the same: document the review and sign off as having reviewed the medications.
Medications that are taken PRN, or as needed, must include parameters or indications (e.g., for pain, when systolic pressure is > X). Additionally, oxygen must be listed on the medication profile, including method of administration (nasal cannula, mask), frequency, flow rate and parameters for its use. Finally, the patient’s medical provider must be notified when there is a medication discrepancy, any side effect, problem or reaction to a prescribed medication. All reported issues, conversations with and orders from the provider must be documented in the record.
Because medications may change during the episode of care, make sure the medication profile is an important part of your agency’s quality assurance activities so you can minimize the likelihood for adverse patient care situations and survey deficiencies.