Medication Management: The Key to Decreasing ACH and ED Use

Adverse Drug Events (ADEs) cause approximately 1.3 million emergency department visits and 350,000 hospitalizations each year, averaging 8,000 deaths annually. It is estimated that more than 40% of ambulatory (non-hospital) ADEs might be preventable. Assisting patients with safe medication management is one of the fundamental services that home health agencies can provide for patients and can lead to a decrease in Acute-Care Hospitalization (ACH) and Emergency Department (ED) use.

As part of every comprehensive assessment, home health agencies are required to complete a Drug Regimen Review (DRR) per the CoP §484.55(c)(5). The implementation of OASIS-E brought a more holistic approach for safe and effective medication management. Best practices have been built into the OASIS to identify drugs in high-risk drug classes, determine if physician/practitioner intervention is required, and prioritize education on high-risk drugs. In addition, OASIS-E provides the opportunity to identify barriers for safe medication management and develop more personalized plans of care.

As part of the assessment at the beginning of care at home, clinicians would ask the patient to show them where they keep their medications, to read the bottles and explain how, when and why they take each medication. In addition, clinicians would ask them to demonstrate their ability to open bottles, select pills, draw up liquids, etc. By doing this, clinicians can assess ambulation (M1860, GG0170), vision (B1000), hearing (B0200), compliance issues (M1033), health literacy (B1300) and safe ability to self-manage meds (M2020, M2030). Identifying these barriers to safe medication management helps determine what interventions need to be on the plan of care to set the patient up for success, improved safety and better outcomes.

When performing the DRR, clinicians can identify medication issues that require immediate follow-up with the provider (M2001, M2003) and resolve the issue before it could lead to an ACH or ED visit. Additionally, clinicians are required to identify specific High-Risk Drug Classes in (N0415) and determine if there is an indication noted for those in N0415. Not only do clinicians need to identify drugs in the six classes listed in N0415, but they also need to identify ALL high-risk drugs (M2010) the patient is taking in ANY class. Clinicians must ensure that the patient and caregiver are taught about any special precautions and how and when to report any problems related to their high-risk meds. Additionally, the new OASIS-E item, O0110 Special Treatments, Procedures and Programs, can aid in identifying other high-risk meds like chemotherapy and certain IV medications that would be considered high-risk. Teaching high-risk meds at the SOC/ROC time points is a critical step to help ensure patient safety and prevent ADEs.

OASIS-E brought to light the need for the healthcare industry to focus more on health equity and the Social Determinants of Health (SDOH). The addition of OASIS item A1250 Transportation, directly addresses if the patient is having difficulty with transportation to access medical appointments and receive their medications. This question is a great gateway to open the conversation about what other issues may be preventing the patient from receiving and taking their medications correctly and safely. These types of questions can guide a clinician to proper interventions to aide in compliant and safe medication management. Identifying SDOH and aiding patients in addressing these issues is imperative to preventing rehospitalizations and ED use.

Lastly, OASIS-E brought several new items (A2120, A2121, A2123, A2122, A2124) related to transfer of health information. The transfer of a current reconciled medication list at the time of discharge or transfer can improve care coordination, quality of care, help subsequent providers reconcile medications and may mitigate adverse outcomes related to medications. Communication of medication information at discharge/transfer is critical to ensure safe and effective transitions from one health care setting to another, as well as to the home. Additionally, a reconciled med list should be given to the patient and/or family at discharge. These items will hold agencies more accountable for maintaining reconciled med lists and improve care coordination, leading to safe patient medication management.

OASIS-E has many items built in to help agencies identify medication issues and barriers to safe self-administration, opening the opportunity for conversations related to these barriers as well as opportunities to educate patients and improve their safe use and self-administration. By addressing these issues and education needs, agencies can help decrease the likelihood that patients will require ACH and/or ED use related to ADEs.

Need help?

Ensuring your staff has the resources and full support to correctly assess and code OASIS-E items is critical during this period of transition to the new data set. While some organizations have adequate staff numbers and resources to transition well, some may find that their organization may not have the capacity to do so. Turning to a trusted partner, such as McBee OASIS Accuracy Services, is a great option. We aim to provide vital resources and education for OASIS-E and put you on the path to adapt, innovate and thrive through change.