Pharmacy F-Tag and Survey Updates - What You …4/4/18 1 Guardian Consulting Services, Inc....

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GuardianConsultingServices,Inc.ConsultantPharmacistsforHealthcareFacilities

PharmacyF-TagandSurveyUpdates-

WhatYouNeedToKnow!

Presentedby:

Dr.WilliamC.Hallett,Pharm.D.,MBA,BCGP,C-MTMPresident/CEO–GuardianConsultingServices,Inc.

[email protected](855)625-6235


GoalsfortheDay

1.  ReviewthePharmacyrelatedsectionsoftherecentlyreleasedupdatestotheStateOperationsManual

2.  Provideanoverviewofwhatweareseeingandexperiencinginrecentsurveys

3.  Outlinepracticalcompliancestrategies


StateOperationsManual(SOM)AppendixPP

BetterknownastheF-Tags•  AKAthe“GuidancetoSurveyors”•  Fullre-writereleasedJune30th,2017;wentintoeffectNovember28,2017

•  WrittentoaccompanytheNovember2016FinalRule,AKAthe“MegaRule”Regulations

•  696TotalPagesofRegulationsandGuidance•  Thisre-writerepresentsatotalre-numbering(andexpansion!)oftheF-Tagsaswehadknownthem!

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StateOperationsManualAppendixPPUpdate

PharmacyRelatedFtagsCrosswalk:F755:PharmacyServices(FormerlyF425)F756:DrugRegimenReview(FormerlyF428)F757/F758:UnnecessaryMedications/PsychotropicMedications(FormerlyF329plusNEW)F759/F760:MedicationErrors(FormerlyF332/F333)F761:LabelingandStorageofMedications(FormerlyF431)F881:InfectionPreventionandControlProgram;AntibioticStewardship(NEW)F883:InfluenzaandPneumococcalImmunizations(FormerlyF334)


StateOperationsManualAppendixPPUpdate

F757UnnecessaryMedications

F758:PsychotropicMedications

Forallthechanges,it’s(mostly)stillallabout(preventingmis)useinDEMENTIA.


F757:UnnecessaryMedicationsandF758:PsychotropicMedications–28Pages

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F758:PsychotropicMedications,continued…


F758:PsychotropicMedicationsKeyrequirements,restated:SpecificConditions;GDR;

TimeLimitsonPRN’s

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Definitionofapsychotropicdrug:

GradualDoseReductionRequirements:


F758:PsychotropicMedicationsDeterminingwhenGDRis“ClinicallyContraindicated”:

EnduringConditions:Psychotropicmedicationsmaybeusedtotreatanenduring

(i.e.,nonacute;chronicorprolonged)condition.


F758:PsychotropicMedicationsDocumenting“ClinicallyContraindicated”:

Scenario1:ChronicEnduringConditionsuchasSchizophrenia,BipolarDisorder,

MajorDepression:

“ContinueSeroquelforchronicenduringconditionofBipolardisorder.Gradual

dosereductionclinicallycontraindicated,residenthighlylikelytodeteriorateand

becomeadangertoselfandothers.”

Scenario2:OtherchronicconditionsOTHERTHANDEMENTIAthatresultin

psychosis

“ContinueRisperdalforchronicpsychosisrelatedtoTraumaticBrainInjury.

Gradualdosereductionclinicallycontraindicated,residenthighlylikelyto

deteriorateandbecomeadangertoselfandothers.”

**InALLOTHERSCENARIOS:GradualDoseReduction(GDR)inanefforttoD/C

MUSTbeattemptedandfailin2consecutivequartersbeforeGDRcanbe

considered“ClinicallyContraindicated”.

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F758:PsychotropicMedicationsRecentSurveyActivityandRecommendations:1.   REMEMBER:ThefocusremainsonDEMENTIA

a)  Makesureyouareidentifyingresidentsonpsychotropicsthathavethe

word“Dememtia”inthediagnosis.TheseWILLbetheeasytargets.

2.   Bepreparedtodefendappropriate,longtermusewithoutGDRuseinMajorDepression

3.   Bewareof“ClassShifting”a)  Anxiolytics(ex:Ativan,Xanax),Anticonvuslantsforbehaviors,and

Antidepressants(forusesotherthandepression)arebecomingjustasbigafocus!

4.   Don’tfallintothetrapof”DiagnosisDrift”a)  Don’twriteSchizophrenia(orBipolarDisorder)unlessthediagnosisis

REAL.b)  Key:UnderstandingthedifferencebetweentheSurveyProcessandthe

CMSFiveStarQualityMeasuresonAntipsychotics

5.   RunandanalyzereportsfromyourEMR,or……



PRNPsychotropics(OtherthanAntipsychotics):•  14days,maybeextendedbeyond14daysprovidedrationale

isdocumentedbythepractitionerandthetimedurationisspecified.–  ThisINCLUDESsleepinductionmedssuchasZolpidem(Ambien).

PRNAntipsychotics:•  Max14days,noexceptions.Ifthepractitionerwishestowrite

anewPRNorder,mayonlydosoafter“evaluatingtheresident”.–  HospiceisNOTexcludedfromthisguidance.

GuidanceonPRNAntipsychoticsandPsychotropics


F758:PsychotropicMedicationsDefinitionof“Evaluating”=“directlyexaminingtheresident”

ComplianceStrategy:ContinuetoavoidPRNantipsychoticsandpsychotropicstotheabsolutegreatestextentpossible.

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ExamplesofKeyElementsofNoncompliance


StateOperationsManualF755:PharmacyServices–14pages


F755:PharmacyServicesConsultantPharmacist’sresponsibilityfor

oversightofControlledDrugrecordkeeping:

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F755:PharmacyServices

BorrowingofMedicationsasasourceofmedicationerrors:


F755:PharmacyServicesRecentSurveyExperienceandComplianceStrategies:1.   MedicationRoomInspectionisstill(often)FIRST

a)  Cleanlinesscounts!b)  Focus:Expiredmeds;Refrigerators;Ekits;NarcBoxes

2.   Expandedchecksoncontrolledsubstanceaccountabilitya)  Checksofnarcboxlocks;refrigeratednarcsb)  Presenceofexpired/discontinuednarcsonunitc)  Examiningdescendingcountssheetsformissingsignatures

3.   SeparateBNEInspectionsa)  Oftenoccurondayofschedulednarcoticinspectionsb)  Includeschecksofhowdiscontinuedcontrolledsubstancesare

storedaftercollectionandawaitingdestructionc)  Makesureyourpoliciesandproceduresareinorder!

1)  ApplicableregulationsappearatTitle10NYCRR80.49and80.50


F756:DrugRegimenReview–10pages

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F756:DrugRegimenReview

TimeFramesforResponsetoDRR’s;Handlingof“Urgent”findings

:


F756:DrugRegimenReviewDocumentationofDrugRegimenReview

Regulation:

Guidance:


F756:DrugRegimenReviewResponsetoDrugRegimenReview:

Compliancemethods:•  WriteupDRRinEMR,physicianrespondsinEMR

Problem:EMR’slackabilitytotrack“open”DRR’s!

•  WriteupDRRonpaper,scantoEMRorfileonpaperchartAFTERphysicianresponds(KeepcopiesinbinderinNursingOffice!)

•  WriteupDRRonpaper,physicianresponds,maintaininbinderuntilaftersurvey,THENscantoEMRorfilewithpaperchart.

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F756:DrugRegimenReview

RecentSurveyActivityandRecommendations:

1.   Sofar,littletonoactionon“prescriberresponseonchart”

2.   HaveyourMedicationRegimenReviewpolicyREADY.1.   Remember:PolicymustspecifyTIMEFRAMES.

3.   Commonpractice:Surveyorsrequest“6Residents/Last6Months”a)  SurveyorrequestsjustONEresident?Usuallyindicatesthereis

anissue/concern.

4.   UsinganEMR?MakesureyouremindwheretheDNS/designeewhereconsultantPharmacistsigns


F759/F760:MedicationErrors–12Pages

Overall– 12pagesofexcellentguidancethatcanbeusefulasa“MedPassTeaching”guide!


F759/F760:MedicationErrors

“SignificantMedicationError”meansonethatcausestheresidentdiscomfortorjeopardizeshisorherhealthandsafety.

Definitions:

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CalculatingMedErrorRates:



:

GuidanceonadministeringcrushedmedsbyORALand

viatheGTroutesindividually:

Somegoodnews…..



:

FromaNovember14th,2017correspondencetotheAmericanSocietyofConsultantPharmacistsMemorandum– CMSwillbe

reversingit’sguidanceonadministeringcrushedORAL

medicationsseparately:

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Additionalareascoveredinthisguidance:

•  Givingadequatefluidwithmedications– Metamucil,Alendronate,Potassium

•  Medicationsthat*must*betakenwithfoodorantacids

•  Potentialforadverseconsequencesfromherbalanddietarysupplements

•  Propereyedropadministration•  MeteredDoseInhalerprocedures


PharmacyF-TagandSurveyUpdates-

WhatYouNeedToKnow!

Presentedby:

Dr.WilliamC.Hallett,Pharm.D.,MBA,BCGP,C-MTMPresident/CEO–GuardianConsultingServices,Inc.

[email protected](855)625-6235

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