Long-Term Care Survey Alert

Find out when meds could put a patient at risk for serious complications.

It is up to your facility’s medical providers to identify the clinical significance of medication that has been prescribed to a patient, according to the Centers for Medicare & Medicaid Services. But the issue must pose an actual or potential threat to the patient’s health or safety, says Judy Adams, RN, BSN, HCS-D, HCS-O with Adams Home Care Consulting in Chapel Hill, NC. Examples of clinically significant medication issues include:

Drug reactions. These are adverse reactions or consequences of taking a drug. A drug reaction may be a secondary effect of a medication that is undesirable and different from therapeutic or any response to a medication that is noxious, and unintended effect such as a rash.

Ineffective drug therapy such as an analgesic that does not relieve pain.

Side effects. These expected, well-known reactions occur with a predictable frequency and may or may not constitute an adverse consequence. For example, bleeding is a side effect of anticoagulant use.

Drug-to-drug and drug-to-food interactions. Serious drug-to-drug, drug-to-food or drug-to-disease interactions can alter absorption, distribution, metabolism, or elimination. These interactions may increase or decrease the effectiveness of the medication or increase the potential for adverse consequences.

Duplicate therapy. Is your patient prescribed both a generic and a brand name drug that are equivalent?

Omissions. Is your patient missing drugs from an ordered regimen?

Dosage errors. Is your patient’s dose too high or too low?

Noncompliance with a medication regimen can be purposeful or accidental; due to impairment or decline in individual’s mental or physical condition or functional or psychological status.

Examples of Clinically Significant Medication Issues

The patient’s list of medications from an inpatient facility discharge list does not match the medications the patient has in the home.

The diagnoses or symptoms for which the patient is taking a medication are not adequately controlled.

The patient seems confused about when or how to take medications. This indicates a high risk for medication errors.

The patient has not obtained prescribed medications or indicates he will not take one or more of them due to financial, access, cultural, or other issues.

The patient exhibits signs and symptoms that are clinically significant adverse reactions from medications he is taking.

The patient takes multiple non-prescribed medications (such as herbs or over-the-counter medications) that could interact with prescribed meds.

The patient has a complex medication plan with medications prescribed by multiple doctors and/or obtains then from multiple pharmacies, putting her at high risk of medication interactions.