Medications - Clinical

Drug Regimen Quick Guide 12.28.18

Drug Regimen Review Quick Guide

The Drug Regimen Review (DRR) is an assessment-based, cross-setting process Quality Measure,
adopted to meet the requirements of the Improving Medicare Post-Acute Care Transformation
(IMPACT) Act domain of medication reconciliation. Potential and actual resident medication
adverse consequences often occur during care transitions and may result in serious harm or
death, emergency department visits, and re-hospitalizations.
The Drug Regimen Review (DRR) is intended to improve resident safety by identifying and
addressing potential and actual clinically significant medication issues at the time of resident
admission and throughout the resident stay. Quality Measure reporting is achieved by coding of
Section N of the Medicare PPS 5-Day and Discharge MDS Assessments.

Drug Regimen Review Process:
  • Medication reconciliation (comparison of current and prior medications)
  • Review of all medications a resident is currently using
  • Review of the drug regimen to identify potential clinically significant medication adverse consequences (any route)Prescribed medications
    • Over the counter (OTC)
    • Nutritional supplements
    • Vitamins
    • Homeopathic
    • Herbal products
    • Total parenteral nutrition (TPN)
    • Oxygen
  • Every time a potential or actual clinically significant medication issue is identified
    throughout the resident stay, it must be communicated to a physician, and the physician prescribed/recommended actions must be completed by the clinician in a time frame that maximizes the reduction in risk for medication errors and resident harm, no later
    than midnight of the next calendar day.

Clinically Significant Medication Issue:
Potential or actual issue that, in the clinician’s professional judgement, warrants communication
with the physician (or physician designee) and completion of prescribed/recommended actions
by midnight of the next calendar day at the latest.
“Clinically significant” means effects, results, or consequences that materially affect or are likely
to affect an individual’s:

  • Mental
  • Physical
  • Psychosocial well-being
  • Positively (by preventing a condition or reducing a risk)
  • Negatively (by exacerbating, causing, or contribution to a symptom, illness, or decline in
    status)

Clinically Significant Medication Issues are potential or actual issues that in the clinician’s
judgement requires communication with the physician or designee and completion of prescribed
or recommended actions by midnight of the next calendar day.

Clinically Significant Medication Issues may Include, but are not limited to:

  • Medication prescribed despite documented mediation allergy or prior adverse reaction
  • Excessive or inadequate dose
  • Adverse reactions to medication
  • Ineffective drug therapy
  • Drug interactions (serious drug-drug, drug-food, or drug-disease interactions)
  • Duplicate therapy (e.g., generic-name and brand-name equivalent drugs are coprescribed)
  • Wrong resident, drug, dose, route, or time error
  • Medication dose, frequency, route, or duration not consistent with resident’s condition, manufacturer’s instructions, or applicable standards of practice
  • Use of medication without evidence of adequate indication for use
  • Presence of a medical condition that may warrant medication therapy (e.g., a resident
    with primary hypertension does not have an antihypertensive medication prescribed)

Any circumstance that does not require this immediate attention is not considered a potential or
actual clinically significant medication issue for the drug regimen review items.

Contact with Physician:
Communication with the physician to convey an identified potential or actual clinically significant medication issue, and a response from the physician to convey prescribed/recommended actions in response to the medication issue.

Two-way communication between the clinician(s) and the physician can be:

  • In person
  • By telephone
  • Voice main
  • Electronic means
  • Facsimile
  • Or by any other means that appropriately conveys the resident’s status