Welcome to our Friday FOCUS on Pharmacogenetics

Each Friday we will post new and relevant information regarding Pharmacogenetics.  We hope you will find this useful and pass along to colleagues.  If you should have any questions regarding pharmacogenetics, please feel free to reach out to us at PGx Medical, info@pgxmed.com or 405-509-5112.

Tag: F329 Unnecessary Drugs
F329 was often cited related to the use of psychotropic drugs, this tag actually relates to the use of all medications. There was a significant period of time in some states where the overuse of Tylenol was cited routinely under F329. Several things have happened with F329 since the release of the new/updated regulations. First, CMS moved F329 from the Quality of Care category and moved it to the Pharmacy Services category, and secondly an entire section of Psychotropic Drugs was added to the definition that will go into effect with Phase 2 (November 2017).  Let’s look at the two-part definition of F329:

Part I of the F329 definition remains essentially the same and pertains to all medications a resident might be using. In essence, F329 requires facilities to ensure that residents are on the lowest dose of all medications possible, and that those medications are used for only the duration of time necessary. Facilities also must ensure that there is a process in place for monitoring the medications and there is an adequate indication or diagnoses for the use of the medication prescribed. Finally, should the resident suffer any adverse consequences related to the use of a drug, then the drug should be reduced or discontinued.

While Part II does not go into effect until one year from now, it would be prudent for facilities to begin providing education and training to all pertinent staff, including nursing staff, physicians, all other prescribers and medical directors regarding this regulation so that they can get into the habit of addressing PRN psychotropics in such a manner that adheres to these new regulatory requirements. Facilities will need to develop an IDT process that strictly evaluates the use of PRN psychotropic medication and ensures that documentation requirements are met for the required time frames. Furthermore, identifying, care planning, implementing and documenting, individualized non-pharmacological behavior interventions is a significant piece to ensuring success related to F329. All staff will need to know and understand how and when behavioral interventions should be utilized and what the ultimate goal is for the resident’s treatment.

The Intent of F329 states: 
“…each resident’s entire drug/medication regimen be managed and monitored to achieve the following goals:

• The medication regimen helps promote or maintain the resident’s highest practicable mental, physical, and psychosocial well-being, as identified by the resident and/or representative(s) in collaboration with the attending physician and facility staff;

• Each resident receives only those medications, in doses and for the duration clinically indicated to treat the resident’s assessed condition(s);

• Non-pharmacological interventions (such as behavioral interventions) are considered and used when indicated, instead of, or in addition to, medication;

• Clinically significant adverse consequences are minimized; and

• The potential contribution of the medication regimen to an unanticipated decline or newly emerging or worsening symptom is recognized and evaluated, and the regimen is modified when appropriate.”

Pharmacogenetics is a great tool to help manage medications.  This no-cost test will provide healthcare professionals with evidence-based reports unique to each individual resident based on their genetic profile.  This allows, allowing physicians, nurses and pharmacists with valuable information to help determine the best medical plan of action as it relates to medication management.  Whether it is psychotropic reduction, drug-on-drug interactions, or a report that helps reduce/increase dosages as appropriate for each individual, pharmacogenetics will provide you with the information needed to help guide you with current medications, and be a roadmap for future medications.

PGx Medical is the trusted and experienced resource for the implementation of pharmacogenetics in the field of aging services. Contact PGx Medical for more information, or to be part of an ongoing operational Pilot Program:

PGx Medical
Individualized Care – Personalized Medicine
info@pgxmed.com
405-509-5112

Source:  Kaile Hilliard, LCSW
Regulatory Compliance Manager-West Division