OASIS Alert

Bonus: Improve outcomes at the same time.

Omitting an accurate medication review in your OASIS assessment not only puts you at risk of a survey deficiency, it can also endanger your patient's life.

One of the top 10 deficiencies cited by state surveyors last year was "Assessments did not include medication review," according to various state survey reports.

Yet medication-related problems are a leading cause of morbidity and mortality in the elderly, warns Los Angles-based home care consulting pharmacist Dennee Frey, author of the book "Improving Medication Management in Home Care."

In fact, if adverse reactions to medications were classified as a distinct disease, it could rank as the third or fourth leading cause of death among people over the age of 65, Frey tells Eli.

Home Health Compare May Suffer Too

Besides the health risks to the patients, home health agencies jeopardize their outcome results when they don't keep up with the patient's medication.

When a comprehensive medication review is not thoroughly or consistently completed on all patients at the required time points, this leads to inaccurate responses to M0780 (Management of oral medications) and inadequate teaching for the patient and family about medication management, reports Sheila Gallant, quality improvement coordinator at Emerson Home Care in Concord, MA.

This failure will show up as a poor result on the outcome "Improvement in management of oral medications," experts say. It could also lead to the adverse event "Emergent care for improper medication administration, medication side effects."

Don't overlook: Watch for medication reviews falling through the cracks in PT only cases. The American Physical Therapy Association has clarified that medication review is part of the scope of practice for therapists, Frey notes.

Poor Outcomes Trigger Targeted Survey

In the enhanced survey process that now focuses on outcomes, the surveyor is instructed to check the agency's rating on improvement in management of oral medications. If the agency is 10 percent lower than the national reference, the surveyor must conduct home visits and/or record reviews in this area. Also, if an agency has at least 30 patients showing "discharge to the community needing medication assistance" -- a Tier 2 adverse event -- this could trigger surveyor scrutiny.

Tip: Check to be sure care plans for patients scoring level "1" or "2" on M0780 consistently include patient and family teaching about medication management.

Errors Are A Major Home Care Problem

Results of a survey of nearly 7,000 home care patients by researchers at Vanderbilt University showed that about one third of them had possible medication errors.Patients in the study were taking a median of five medications and 19 percent of them were taking nine or more meds.

Medication errors increase as the number of medications the patient is taking increases, reports June Simmons, president/ CEO of Los Angeles-based Partners in Care Foundation.

Home health patients are especially likely to experience medication problems because they may have multiple chronic conditions, cognitive problems, several sources of prescriptions, multiple informal caregivers or perhaps live alone, experts say.

Planning: Four common medication errors targeting in the Vanderbilt study were:

• Unnecessary therapeutic duplication;

• Cardiovascular medication problems;

• Falls and confusion related to psychotropic drug problems;

• Problems with non-steroidal anti-inflammatory drugs.