CMS Update on Medication Errors and Pharmacy Services

Please note that the Centers for Medicare & Medicare Services issued clarification on items relating to medication errors and pharmacy services in a letter dated November 2, 2012. As per this letter, information is provided on the following three areas:


  • Medication Errors: Potential medication errors related to medication administration via feeding tube and administration timing for metered dose inhalers and proton pump inhibitors and survey implications.
  • Medication Administration Practices: The practice of “borrowing” medications and issues related to diversion, control, reconciliation and disposal of medications, including fentanyl patches.
  • Medication Regiment Reviews for Stays under 30 Days and/or Changes in Condition: The need for pharmacist medication regimen reviews when a resident experiences a change in condition and/or for residents admitted for less than 30 days.

The full body of this letter can be viewed on the CMS website for further information.

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