Articles

Access to Patient Medical Records

• HIPAA regulations give providers some latitude in sharing patient health information - basically, the provider has the ability to share information if he/she believes it is in the patients best interest.  However, there is a considerably higher standard for granting access to the actual Medical Record.  This link _{[PDF Mirror]} takes you to an excellent article written by the Attorney Kenneth Burgess - of the law firm Poyner & Spruill, LLP.  Ken's article clearly spells out how to rank priority for granting access to a medical record when there are multiple candidates. In Long Term Care, this can become an issue when family members are at odds about treatment elections specified in a MOST form.  Use the decision tree in Ken's article as a guide to sort-out who has priority.

Long Term Care Information

• 2012 - Palliative Care, North Carolina Resource Guide.

• CMS - Skilled Nursing Facility Prospective Payment System - This is how Medicare Part A reimburses for skilled nursing facility care.
• JCAHO - 2010 National Patient Safety Goals for LTC - National Patient Safety Goals
  • This chapter addresses the 2010 National Patient Safety Goals, requirements, and implementation expectations.  The purpose of The Joint Commission's National Patient Safety Goals is to promote specific improvements in patient safety.  The goals highlight problematic areas in healthcare and describe evidence and expert-based consensus to solutions to these problems.  Recognizing that sound system design is intrinsic to the delivery of safe, high quality healthcare, the goals generally focus on system-wide solutions, wherever possible.
  • http://www.jointcommission.org/NR/rdonlyres/5274F44E-E45B-4A29-8D92-F3500EAC4DE6/0/RevisedChapter_LTC_NPSG_20090924.pdf

Drug Information

Spring 2009 - DEA sanctions LTC Pharmacies; likely to trigger onerous new prescribing requirements for everyone.  In recent weeks, federal Drug Enforcement Admininistration (DEA) agents have conducted inspections in several long-term care (LTC) pharmacies in Ohio.  The agents are focusing on several areas of concern including:

• Dispensing CII, III, IV and V drugs based upon a chart order faxed by the facility to the pharmacy. DEA does not consider a chart order to meet the legal requirements of a valid prescription order under 42 CFR 1306.21.  DEA also does not recognize the LTC nurse as the agent of the prescriber.
• Dispensing III, IV and V drugs upon the oral orders of the LTC nurse, after the nurse has received the the order from the physician.  Again, the DEA does not recognize the LTC nurse as the agent of the prescriber.
• Using the exception for emergency orders for non-emergencies, including situations where the need for the drug could have been anticipated by the prescriber/pharmacy failed to timely obtain a new prescription.
• Drugs dispensed from an e-box without a valid prescription.

The American Society of Consulting Pharmacists published a Q & A bulletin describing the DEA's rules for prescribing in the LTC setting.  These differ vastly from common industry practice.  Read the Q & A here.  ECP's management company, Geriatric Practice Management, is developing an e-fax solution for scheduled drugs that should be both compliant and less onerous than managing paper faxes.  This should be ready by mid June 2009.

• Effects of Common Drugs on PT/INR values - This handy pamphlet provides qualitative descriptions of the effect of commonly used pharmaceuticals on PT/INR values.  It can help clinicians better understand possible underlying causes contributing to changes in these laboratory values.  The pamphlet was originally produced by Medical Review of North Carolina, Inc. under a contract with the Centers for Medicare & Medicaid Services (CMS), formerly HCFA.
• Excerpts from the CMS State Operations Manual F329.  The three following tables are excerpted from Appendix PP of the State Operations Manual.
  • CMS List of Unnecessary Medications - a modification of the Beers List
  • Anticholinergic Drugs
  • Common Medication-Medication Interactions
• 2002 Beers List- Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
  • Results of a US Consensus Panel of Experts - Link to Archives of Internal Medicine article updating a list of medications with potential adverse effects in older adults.  This list is employed by Nursing Home Surveyors as a screening tool.  While some of these medications are appropriate to use in a LTC setting, clinicians should take extra steps to document the reasons for use of a listed medication.