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Medical FAQ



Spotlight: New Regulations Guidelines - Regarding Prescriptions

What are the new regulatory guidelines that recently went into effect regarding medication prescribing in the long-term care setting?

What is an "unnecessary medication"?

How will these new Federal guidelines affect the way medications are administered at The Hebrew Home?

What about patients already receiving anti-psychotic medications?

What is a “gradual dose reduction”?

What if the behaviors/symptoms recur?

Are sleeping pills subject to gradual dose reductions?

What services are available through the Home’s clinic?

What are the new regulatory guidelines that recently went into effect regarding medication prescribing in the long-term care setting?
On December 18, 2006, the Centers for Medicare and Medicaid Services (CMS) issued a comprehensive update to their pre-existing regulations governing the way medications are prescribed and monitored in the long-term care setting. The essence of these changes is geared toward the avoidance and discontinuation of unnecessary medications.

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What is an “unnecessary medication”?
The guidelines address all classes of medications and define an unnecessary medication as any medication that is prescribed:

a. in an excessive dose
b. for an excessive duration
c. without an adequate indication for its use
d. in the presence of side effects.

The goal of these updates is to ensure that each resident’s medication regimen helps achieve or maintain the highest level of physical, mental, and psychosocial well-being.

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How will these new Federal guidelines affect the way medications are administered at The Hebrew Home?
The most significant changes relate to the usage and monitoring of anti-psychotic medications. Under the new guidelines, residents who have not previously used anti-psychotic meds are not prescribed them except to target a specific condition, as diagnosed in the medical record. These medications will be used only after non-pharmacological interventions have proved ineffective at controlling the target symptoms, with subsequent referral to the consultant psychiatrist for psychopharmacologic treatment options. The guidelines apply to any medication that is being prescribed to treat psychiatric disease and/or control behaviors.

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What about patients already receiving anti-psychotic medications?
As per the CMS guidelines, a gradual dose reduction will be attempted in two consecutive quarters, with at least a one month interval in between, unless deemed to be clinically contra indicated, and will be repeated annually.

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What is a “gradual dose reduction”?
A gradual dose reduction is the stepwise tapering of a drug dose to determine if symptoms, conditions, or risks can be managed by a lower dose, or if the drug can be discontinued completely. It is important to appreciate that a series of behaviors or symptoms that warranted anti-psychotic medication may have resolved, and that the patient may longer require the use of this drug.

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What if the behaviors/symptoms recur?
The purpose of these guidelines is to maintain each patient on the least amount of medications needed to maintain the highest level of functioning. If the dose reduction results in a return or worsening of symptoms, as monitored by the clinical team and the consultant psychiatrist, the patient will be restored to the previously effective dose.

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Are sleeping pills subject to gradual dose reductions?
Yes. Insomnia should be addressed initially through non-pharmacologic approaches, including increasing physical activity and avoiding daytime naps. To improve the sleep-wake cycle, other factors that inhibit sleep, i.e. caffeine intake, will be reviewed by the clinical team. A gradual dose reduction quarterly is required, unless clinically contra indicated.

If you have further questions regarding your relative’s medication, or any other concerns relating to your family member’s medical care, please contact their neighborhood physician directly, or the medical department at 718-581-1200.

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What services are available through the Home’s clinic?
A full complement of specialty services are available as follows:

Cardiology

Internal Medicine

Palliative Care

Dermatology

Nephrology

Pathology

Endocrinology

Neurologist

Physiatry

Gastroenterology

Oncology

Podiatry

General Surgery

Opthalmology

Psychiatric

Gynecology

Optometry

Psychology

Hematology

Orthopedic Surgery

Psycometrician

Otolaryngology

Pulmonary Medicine

 

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