Ensuring Accuracy of the MDS, Section O: Medications

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Ensuring Accuracy of the MDS, Section O
Medications
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Importance of MDS AccuracyMDS Affects

• Residents Care Plan
• Facilitys 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

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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)

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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

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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

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What is counted as a medication?

• Clarification on topicals
• Includes creams, ointments, etc.
• Includes wound care treatments, but NOT
  moisturizers or moisture barriers

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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

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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
• Physicians Office
• Hospital
• Combination products that include 2 or more
  active medications are counted as 1 medication

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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

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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

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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

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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

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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

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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-daylook 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)

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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

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Contact information

• Carla Saxton, RPh, CGP
• American Society of Consultant Pharmacists
• E-mail csaxton_at_ascp.com