CMS Regulations For Specialized Pharmacy Services
The Medicare Modernization Act of 2003 recognizes that beneficiaries who reside in long term care facilities have needs for specialized pharmacy services, have access to a pharmacist 24 hours per day, seven days per week, and emergency deliveries of medication to assure residents receive timely access to appropriate medication therapies (CMS, 2014). To meet this type of service, many long term care facilities have contract with long-term care pharmacies (LTCP).
Standards of practice for LTCP have evolved over several decades in response to a complex set of Federal and state regulations governing the provision of prescription drugs in the LTC setting (CMS, 2014). The law that regulates the practice of pharmacy in nursing facilities are developed to safeguard the health and well being of nursing facility residents. This group of population have atypical care needs that would require alternative forms of medication or more intensive medication management. Federal law regulation mandates LTC facility in conjunction with LTCP to develop a system to decrease medication errors and adverse drug events; assure proper medication selection; monitor drug interactions; assess for over-medication, and under- medication; improve medication documentation (CMS, 2014). In order to be compliance with the federal law, it is imperative that the pharmacy and nursing facility work collaboratively to develop policy and procedure that meet the regulations.
CMS Recommendations of LTCP Practice
Generally, LTCPs work with nursing personnels and physicians to establish appropriate medication regimens for incoming residents and obtain prescription orders. Pharmacists in the LTCP make recommendatio...
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...the capacity to deliver emergency medications when ordered. If the LTCP contracts with a back-up community pharmacy, then this pharmacy will also be required to deliver the medications to the nursing facility (CMS, 2014).
Multiple steps are conducted to ensure that medications received and administered to nursing facility residents are the intended ones. Nursing facility regulations specify that the facility “must develop and implement appropriate policies and procedures for accurate acquiring, receiving, and administering of all medications” (CMS, 2014). Before medications are packed for delivery, a LTCP employee checks that individual content of a package match the prescription label on the package (CMS, 2014). It is crucial for the nursing staff to be conscientious on the order submission cut-off time so the medications can be delivered as soon as possible.
...vacy screen on the computer and/or turning the computer away so customers cannot see what’s on the screen, and use a secure network to receive new prescriptions or request refills. A patient must be notified and give authorization to allow a list of their drugs be given to a marketing company. The authorization must say what the data disclosure and use is being planned for and the date when the authorization will expire. In a community practice a pharmacist cannot discuss treatment with anyone unless patient signs authorization. In an institutional practice the patient can call the pharmacist and give permission to talk to a doctor if able to speak. In case of an emergency, such as a heart attack or car accident, the doctor can call the pharmacist to get the information without patient consent. A patient must give a written authorization in a community pharmacy.
...estions if not 100% sure of something or use a double checking system. When a nurse is administrating medication, they should use the ten rights of medication administration (right patient, right drug, right route, right time, right dose, right documentation, right action, right form, right response, and right to refuse). Nurses should always keep good hand hygiene and always wear appropriate clothing to prevent from the spread of disease. Good communication with patients and healthcare team members is also key to success. Keeping on the eye on the patient within an appropriate time is important. If the patient ever seems to be looking different than their usual self vitals should be taken immediately. Encouraging patients to ask questions if they are unaware of something can prevent errors as well. Nurses should make sure the patient is on the same page as they are.
Overall, I retain three goals for this clinical day: Safely and efficently administer medication, enhance my nursing/CNA skills, and determine how to implement infection control into a health care setting. This week reflects my assigned time to administer medication in a health care setting for the first time, with a resident who retains nearly twenty medications. I except this experience will be a great learning experience, but it will also subsist slightly stressful. With the assistance of my FOR, my goal is to administer all of my resident 's medications without complications. To ensure that medication safety, I will perform the six medication rights and three checks prior to administration. Along with medication administration, a goal
McLeod, M., Ahmed, Z., Barber, N., and Franklin, B. D. (2014). A national survey of inpatient medication systems in English NHS hospitals. BMC health services research, 14(1), p93.
The main quality initiative affected by this workaround is patient safety. The hospital switched to computer medication administration as opposed to paper medication administration documentation because it is supposed to be safer. So, when the nurse gets the “wrong medication” message the computer thinks something is wrong, this is a safety net that is built into the computer system. If the nurse were just to administer the medication without any further checks, he or she would be putting patient safety on the line. The policy involved that pertains to this workaround is the “8 rights of medication administration”, which are: right patient, right medication, right dose, right route, right time, right documentation, right reason, and right response (LippincottNursingCenter®, 2011). Each nurse it taught these eight rights of medication administration in nursing school, therefore it is a nursing policy. When this workaround occurs the nurse should use his/her judgment before “scan overriding” and ensure these eight checks before administering the
Over the past years the role of a Nurse Practitioner (NP) continues to advance allowing them to gain more access to patient care including furnishing drugs and devices. Furnishing is process of ordering drugs/devices and making it available to the consumers. The furnished drugs/devices should agree upon the standardized protocol of the supervising physician or the company where an NP is working (BRN, 2004). According to Board of Registered Nursing (BRN) in order to allow the NP to furnish medications and drugs, the NP should complete an advanced pharmacology course from a nationally accredited post-master’s or master’s level academic institution and file an application to Board of Registered Nursing (BRN, 2012).
Two pharmacists have to verify orders on any pediatric medication, chemotherapy medication, and heparin drip orders. Intravenous medications are checked with order verifications, during processing, after processing, and as the ingredients are logged. Medications are then placed into the PYXIS dispensing machine and always counted twice and then documented on an electric log. All medications have expiration dates and are stocked until expired, once expired they are pulled from the dispensing machine and discarded. At bedside, nurses scan medications to confirm that it is the correct medication that was
The purpose of this paper is to discuss how Electronic Medical Records (EMR), affects healthcare delivery. I will discuss the positives and negatives this issue has on healthcare and how it effects the cost and quality for healthcare services. In addition, I will identify any potential trade-offs to cost or quality. Lastly, I will discuss how the EMR affects my job as well as any challenges or opportunities this issue presents.
Responsibility and accountability become important when medical staff gives or doses patients with medication. The chance for making a medication error presents itself at all times. Those passing medications must follow established policies and procedures developed and laid forth by t...
PICO Question: Among the elderly patients receiving care at Cary Medical Center on Med/Surg, who are currently taking multiple medications due to comorbidities, would reviewing medications at each provider visit reduce polypharmacy and its associated adverse reactions?
medications is more than the act of getting drugs to a patient. The delivery of medication is directly tied to the charge for the medication. Thus the responsibility for charging or crediting medication belongs to technicians. This aspect of their job is strictly governed by federal regulations. These laws hold the technician directly responsible for the accuracy of a patient’s account’s charge and credit transactions. Because every dose is related to a specific day and time, when technicians credit they must apply that change to the corresponding dose. Assignificant as accuracy is to the patient’s account, accuracy in the making of their medications is even more important.
PICO Question: Among the elderly patients receiving care at Cary Medical Center on Med/Surg, who are currently taking multiple medications due to comorbidities, would reviewing medications at each provider visit reduce polypharmacy and its associated adverse reactions?
Drug administration forms a major part of the clinical nurse’s role. Medicines are prescribed by the doctor and dispensed by the pharmacist but responsibility for correct administration rests with the registered nurse (O'Shea 1999). So as a student nurse this has become my duty and something that I need to practice and become competent in carrying it out. Each registered nurse is accountable for his/her practice. This practice includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse drug reactions and teaching patients about the drugs that they receive (NMC 2008). Accountability also goes for students, if at any point I felt I was not competent enough to dispensing a certain drug it would be my responsibility in speaking up and let the registered nurses know, so that I could shadow them and have the opportunity to learn help me in future practice and administration.
Care planning is one of these tasks, as expressed by, RNCentral (2017) in “What Is a Nursing Care Plan and Why is it Needed?” it says, “Care plans provide direction for individualized care of the client.” A care plan is for an individual patient and unique for the patient’s diagnosis. It is a nurse’s responsibility to safely administer a patient’s medication prescribed by the doctor. Colleran Michelle Cook (2017) in “Nurses’ Six Rights for Safe Medication Administration,” she says, “The right patient, the right drug, the right dose, the right route and the right time form the foundation from which nurses practice safely when administrating medications to our patients in all health care settings.” Nurses must be safe when dealing with medications, and making sure they have the right patient. Nurses document the care that is given to their patient, as said by, Medcom Trainex (2017) in “Medical Errors in Nursing: Preventing Documentation Errors,” it states, “Nurses are on the front lines of patient care. Their written accounts are critical for planning and evaluation of medical interventions and ongoing patient care.” Nurses must provide an exact, complete, and honest accounts of everything that happens with a patient. Doing this allows for the proper evaluation, and medical interventions for the patient. The typical tasks a nurse involves care planning, administration of treatments and medication, and documenting the care given to a
Medication errors are the leading cause of morbidity and preventable death in hospitals (Adams). In fact, approximately 1.5 million Americans are injured each year as a result of medication errors in hospitals (Foote). Not only are medication errors harmful to patients but medication errors are very expensive for hospitals. Medication errors cost America’s health care system 3.5 billion dollars per year (Foote).Errors in medication administration occurs when one of the five rights of medication administration is omitted. The five rights are: a) the right dose, b) the right medication, c) the right patient, d) the right route of administration, and e) the right time of delivery (Adams). Medication administration is an essential part of the nursing profession, taking up to forty percent of a nurse’s time in providing nursing care (Fowler). Consequently, nurses are commonly held accountable for medication errors. To improve the safety of a vital aspect of nursing care, bar code scanning was introduced to reduce errors in medication administration. Although bar code scanning has its advantageous aspects, there are also disadvantageous qualities.