Home Health & Hospice Week

Improving medication management is one key to decreasing avoidable hospitalizations and improve patient outcomes -- not to mention avoiding publicly reported adverse events. Accurately assess your patient's ability to manage his oral medications with recent resources from the Centers for Medicare & Medicaid Services.

M2020 (Management of oral medications), which is collected at start of care, resumption of care, and discharge, asks you to assess your patient's current ability to prepare and take all oral medications reliably and safely. This includes the ability to administer the correct dose at the right time.

Answer M2020 based on the patient's ability, not necessarily on his actual performance, willingness, or compliance, says certified OASIS expert Ann Giles, director of ICD-9 coding & OASIS review services with Biloxi, Miss.-based PPS Plus Software.

When answering M2020, assess the following, CMS says in a recent online training module:

• Deficits with vision, memory, or judgment;
• Ability to read the medication bottle;
• Ability to take the right medication, at the right time, every time;
• Environmental barriers such as access to the kitchen or other medication storage areas, stairs, narrow doorways;
• Physical impairments such as limited manual dexterity; and
• Ability to manage all oral medications.

For example: Suppose you are caring for an elderly patient. His wife brings him his medication each morning, but there is no reason he couldn't get out of his chair to get the medication himself. You could mark this patient 0 -- Able to correctly take the correct oral medication(s) and proper dosage(s) at the correct time, Giles says.

Actually observing your patient's ability is essential for this item. First, ask your patient the basic question, suggests Fazzi Associates in its  OASIS-C Best Practice Manual: "Can you tell me which medications you take?" Then CMS suggests  that you ask questions like:

• What time do you take these medications?
• How many times a day do you take them?
• Does your family or a care taker set up a pill planner for you?
• Is the pill planner correct?

For a practical demonstration of your patient's ability, have him read the medication bottle and assess his ability to read and explain the administration of the medication, CMS suggests. Or, ask the patient to prepare his medication for the day and assess his knowledge and ability to accurately prepare his medication. This method allows you to assess his ability even if there are literacy issues.

Remember to consider your patient's physical, mental, emotional, and cognitive statuses when answering this question, Giles says. "If your patient has dementia, is he really able to take his medication reliably and safely?" Or if your patient had a total joint replacement and the pain medications are making her groggy, is she able to manage her medicationsreliably and safely?

Don't forget to include assessment of all the activities surrounding the medication administration, Fazzi reminds agencies: getting the medication from where it is stored, opening bottles, pouring, breaking tablets, etc.

For instance: Say your patient has been on Norvasc, iron, and a beta blocker for the past three years. He takes these medications every day at the same time with no problem. But now he has recently been put on Coumadin and just can't seem to get into the routine. He is confused about which dosage  to take which day of the week. He can't get the hangof it. Answer M2020 based on the level of assistance he needs with the Coumadin, Giles says.

If your patient uses a pill box or sets a time to remind himself to take his medications, is he automatically dependent? No, says CMS. If the patient  sets up his own planner device and is able to take the correct dose at the correct time, you can score him 0 -- Able to correctly take the correct oral medication( s) and proper dosage(s) at the correct time. But if your patient is independent in taking his oral medications provided another person sets up his planner and/or develops a drug diary he relies on to take his medications appropriately, you would respond 1 -- Able to take medication(s) at the correct times if individual doses are prepared in advance by another person or another person develops a drug diary or chart.

And if your patient requires daily reminders to take his medications, whether or not he can prepare his own individual doses and/or keep his drug diary, you'll respond 2 -- Able to take medication(s)at the correct times if given reminders by another person at the appropriate times.

Remember: If your patient lives in an assisted living facility, "focus on ability, not policy of facility on medication storage/distribution," Fazzi adds in the manual.