F-Tag of the Week
We’re breaking down the Requirements of Participation Phase 2 updates and Phase 3 new guidance.
  • Today we’re focusing on F755, F757, and F758.
  • Look for additional updates each week through October.

  • The series starts August 3.
§483.45-Pharmacy Services
What’s new: CMS has revised the §483.45-Pharmacy Services guidance as follows: 

F755-Pharmacy Services: Clarifies how to dispose of Fentanyl patches. 
  • Provide training to staff on proper disposal.


F757-Drug Regimen Is Free from Unnecessary Drugs: Adds language on antibiotic stewardship and F881. 
  • Evaluate current Antibiotic Stewardship Program to ensure use of infection assessment tools and monitoring of antibiotic use.
  • Give feedback and education to prescribers so unnecessary antibiotic use is not taking place.
 
F758-Free from Unnecessary Psychotropic Medications/PRN Use: Clarifies other classes of drugs not listed in the regulation and how they are affected by the psychotropic medication requirements. New language was added on potential misdiagnoses, such as schizophrenia, in order to prescribe antipsychotics. 
  • Identify residents currently receiving other medications (antihistamines, anticholinergics, and central nervous system agents) with a documented use that appears to be a substitute for an antipsychotic, anti-depressant, anti-anxiety, or hypnotic.
  • Review all residents with a schizophrenia diagnosis to make sure the medical record includes detailed evaluations by appropriate practitioners and relevant history consistent with professional standards.
  • Review residents who receive a new active diagnosis of schizophrenia after admission to ensure residents’ medical records included detailed evaluations by appropriate practitioners that include documentation of persistent behaviors for the six months prior to the start of the antipsychotic medication in accordance with professional standards to ensure proper coding on the MDS. (Cross referenced with I6000 coding Schizophrenia on MDS. See MDS 3.0 RAI User's Manual (v1.17.1R) Errata (v2) for more info.)


Action for facilities:
  • Form a team (administrator, DON, medical director, consultant pharmacist, staff nurse, social worker) to champion compliance and improvement efforts on pharmacy services and medication management.
  • Develop a plan for communicating with physicians/prescribers about response requirements to drug regimen reviews.
  • Explore ways to offer behavioral interventions as alternatives to psychotropic medications.


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