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OASIS Alert

Survey & Certification:

Act Now To Reduce Medication Error Risks

Published on Wed Aug 17, 2005

Improve outcomes at the same time.

Neglecting to include an accurate medication review in your OASIS assessment not only puts you at risk of a survey deficiency - but also endangers your patient's life.

Number four of the top 10 deficiencies cited by surveyors last year was "Assessments did not include medication review," according to the Centers for Medicare & Medicaid Services' Division of Continuous Care Providers, the National Association for Homecare & Hospice reports.

Yet "medication-related problems are a leading cause of morbidity and mortality in the elderly," warns Los Angeles-based home care consulting pharmacist Dennee Frey.

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.

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 increased as the number of medications the patient was taking increased.
 
Home care 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 targeted in the Vanderbilt study were:
 

  • unnecessary therapeutic duplication;
     
  • cardiovascular medication problems;
     
  • falls and confusion related to psychotropic drug problems; and
     
  • problems with non-steroidal anti-inflammatory drugs.

    Home Health Compare May Suffer, Too

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

    A comprehensive medication review that is not thoroughly or consistently completed on all patients at the required timepoints leads to inaccurate responses to M0780, reports Sheila Gallant, quality improvement coordinator at Emerson Home Care in Concord, MA. This failure also results in inadequate teaching for the patient and family about medication management, she adds.

    This will show up as a poor result on the outcome "Improvement in management of oral medications," experts say.

    Typical problems with medication reviews are incomplete medication lists, patients not telling clinicians about new meds, and errors in collecting or analyzing the information, experts say. Rarely are medication reviews completely missing, auditors report (see the following article, below, for tips).

    Don't overlook: Check to be sure medication reviews don't fall 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

    Watch for: In the enhanced survey process that now focuses on outcomes, the surveyor will check the agency's rating on improvement in oral medication management. 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.

    Note: For a list of medications to avoid or use with caution in the elderly, go to     www.ompro.org/homehealth/homehealthresources.html.

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