Home care accreditation standards of The Joint Commission require compliance in several areas, including medication management, with non-compliance possibly resulting in conditional deficiencies for applying home health agencies. Some important areas to assess for compliance regarding a home health agency medication management program are:
a. Do progress notes make reference to a new medication? Do the progress notes have evidence that the patient was asked about medications? Make sure the referenced medication is listed on the medication list! The patient record summary should be continuously updated as orders are received and carried out. At least monthly, review medical records comparing medications to those listed on the medication profiles. Take a look at NPSG.03.06.01 Note 3, for the definition of “good faith” effort. Documentation of supporting assessments with each visit, along with a monthly review, is evidence of a “good faith” effort!
B Lack of evidence of drug regimen review can be a potential hazard in the Joint Commission accreditation process, as can lack of evidence of physician notification in the event of drug interactions. Drug regimen reviews performed by a licensed professional who can take an order, such as a nurse, physical therapist or occupational therapist, should occur at start of care, recertification and when there are changes in the medications ordered. Anytime there is a note in the record regarding a drug interaction there should also be a note or recording of successful attempts to contact the patient’s primary physician, or an agent of the primary physician, such as an office nurse.
c. Patient education is also important in accreditation Does your facility’s documentation support the patient being educated about their medication, and, if so, what type of education was given? Information should include what to watch for, in regards to side effects, as well as any possible drug interactions.
d. If a new medication is an antibiotic, is the antibiotic review included in the agency’s Infection Control program? Daily clinical notes should be reviewed, and when there is an antibiotic listed, an infection screen form must be completed so that the antibiotic is captured in the Infection Control program.
e. Did you know that National Patient Safety Goal 8 has now been changed to Standard 3.06.01s? What does your agency need to do to work toward meeting the national goal for Patient Safety?
f. During the monthly review of medication regimen, inquire if the patient is taking medications as ordered. The nurse can also assess if the patient discontinued the medication. For instance, if the medication is dated 1/1/2011 and today is 2/1/2011 (medication ordered for daily use), is there half a bottle of medication remaining? Findings such as insulin non adherence, or discontinuing potassium when taking a diuretic, would be some examples of problem areas.
Daily review of progress notes can lead to identification, prevention and/or corrections of medication – related administration issues , and prevention and / or correction of problems as they occur. Keep a list of those patients whose medication administration is the reason for a home health visit, and include several of these patients in the comprehensive chart review. Hold staff accountable.
A free resource for drug interactions with severity levels: http://www.drugs.com/drug_interactions.html. The site offers teaching guides too, and it is free.