EXAM 3 Long-Term Care Facilities Federal Regualtions Flashcards
Who is the primary payer of LTCFs?
The government
-Medicare
-Medicaid
What must LTFCs provide?
drugs or an agreement to provide them
typically they have a contract with an external pharmacy
-must have a licensed pharmacist who
provides consultation and pharmacy services
Establish controlled substance record keeping and reconciliation (monthly) !!
How often does the responsible pharmacist need to review the drug regimen (DRR) and the medical chart?
Monthly
How often does a pharmacist who is responsible for an LTFC have to maintain record keeping of the controlled substances?
monthly
REMINDER: inspections are quarterly (1140-14)
To whom must the pharmacist of the LTCF report irregularities after completing the DRR and the medical chart?
-attending physician
-medical director
-Director of Nursing
irregularities:
-an unnecessary drug
-others deemed by the pharmacist
only report irregularities??? what is considered irregularities??? what if the DRR is fine, does the Rph still have to report???
Who is responsible for the DRR and policies and procedures (P&P)?
The facility
the pharmacist plays a role in establishing those
What examples of unnecessary drugs?
-Excessive dose
-Duplicate drug therapy
-Excessive duration
-Inadequate monitoring
-Inadequate directions for use
-Those that should be reduced/DC’d given adverse consequences
What are Psychotropic Drugs?
drugs that affect brain activities associated with mental processes and behavior
-antipsychotics
-antidepressants
-anti-anxiety
-hypnotics
What are the rules for administering Psychotropic drugs?
-patients in the LTCFs shouldn’t be on these drugs unless there is a diagnosis or a condition that warrants it
-For those prescribed psychotropics, gradual dose reductions and behavioral interventions in an effort to DC
-shouldn’t use psychotropic PRN dosing unless there is a diagnosis or condition that warrants it
-PRN orders for psychotropic are limited to 14 days: unless they have a prescription and a rationale
-PRN orders for antipsychotics are limited to 14 days: can’t be renewed without evaluation
Examples of Medication errors
-Not in accordance with the prescriber’s order
-Not in manufacturer’s specifications regarding prep and administration
-Not in acceptable professional standards and principles
What is the maximum rate of medication errors in LTCFs?
5%
What is the dispensing maximum for Part D drugs?
14 days
purpose: minimize waste since the patient population here is elderly and close to death
can be less: pharmacy may reduce it for example to a 7-day supply to be more efficient - payers cant penalize efficiency
What are the exceptions of the 14-day dispensing rule for LTFCs?
-solid oral antibiotic
-solid oral doses in FDA-approved compliance packaging (oral contraceptives -> can use the whole package)
The 14-day rule is waived for which type of facilities?
the requirements are waived for intermediate care facilities and institutes for mental disease
