Ensuring Accuracy of the MDS, Section O: Medications

Importance of MDS Accuracy…MDS Affects: Resident’s Care Plan Facility’s Reimbursement/Payment Quality Indicator Data –5 of the 24 QIs are based on Section O Quality Measures Data Health Care Providers’ Assessment and Subsequent Care of the Resident

Section O: Medications O1: Record the number of different medications used in the last 7 days. Where is the best place to get this information? Medication Administration Record (MAR)

What is counted as a medication? Over-the-counter (OTC) and prescription (Rx) medications Routine, PRN (as needed), and STAT medications Oral, topical, ophthalmic, otic, suppositories Vitamins Vaccines and antigens

What is counted as a medication? Medications actually administered; Ordered medications not given should NOT be counted Long-acting preparations, even if they were administered prior to the 7-day assessment period

What is counted as a medication? Clarification on topicals… –Includes creams, ointments, etc. –Includes wound care treatments, but NOT moisturizers or moisture barriers

What is counted as a medication? Clarification on vitamins… –Multivitamin counted as 1 medication –Liquid dietary supplements that contain vitamins and minerals (e.g., Ensure) are NOT counted –TPN solutions are NOT counted, but vitamins, electrolytes, or other medications (e.g., insulin) added to the TPN are counted –Herbal and alternative products are NOT counted

What is counted as a medication? Include medications that are administered by: –The facility –The resident –Outside health care providers, such as… Dialysis/ Chemotherapy Clinic Physician’s Office Hospital Combination products that include 2 or more active medications are counted as 1 medication

What is considered a medication? Insulin… –Different types of insulin are counted as separate medications –Combination insulins (e.g., 70/30 mix) would be counted as 1 medication Heparin used to flush IV lines is NOT counted as medication

Section O: Medications O2: Is the resident receiving medications that were initiated during the last 90 days? –Not asking for number, just “YES” or “NO” response –If the new medication was initiated in the last 90 days, but was discontinued prior to the assessment, this would NOT be considered a new medication

Section O: Medications O3: Record the number of DAYS injections of any type were received during the last 7 days. Includes: –Medications, antigens, vaccines –Routes of administration: Subcutaneous - [include subcutaneous pumps only if SQ injection required to restart pump] Intramuscular Intradermal NOT Intravenous (IV) - [Section P]

Section O: Medications O4: Record the number of DAYS during the last 7 days the resident received the following medications: –Antipsychotic –Antianxiety agent –Antidepressant –Hypnotic –Diuretic

Section O: Medications O4…. –Code according to pharmacological classification, not how the medication is being used in the resident –Coding according to the pharmacological class ensures proper monitoring of side effects

Common Discrepancies/Errors 7-day “look back” period is not being taken into consideration PRN and STAT doses are mistakenly not counted Medications utilized prior to an admission but within the 7-day”look back” period are not being captured –Discharge or transfer records from sending facility/hospital should be reviewed for documentation of the administration of medication(s)

Common Discrepancies/Errors Number of DRUGS is counted rather than the number of DAYS (Items O3 and O4) IV medications are being considered (Section P instead) PPD tests for tuberculosis are mistakenly not included in the count

Contact information: Carla Saxton, RPh, CGP American Society of Consultant Pharmacists