by PGx Medical | Dec 9, 2016 | Uncategorized
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
by PGx Medical | Dec 2, 2016 | Uncategorized
Gene mutations that affect drug metabolism may explain higher hospitalization rates in some older adults taking multiple medications, according to researchers from Columbia University.
Nearly 40 percent of Americans 65 or older take at least five or more medications.
Polypharmacy (the use of multiple medications), is on the rise among U.S. seniors, according to an article in Sciencedaily.com. The article states, approximately 40 percent of Americans 65 or older take at least five or more medications. Previous studies have shown that older adults with polypharmacy are more prone to adverse events and hospitalizations than those taking fewer medications. However, few studies have investigated individual, genetic risk factors for adverse drug events in this population.
For this small pilot study, the researchers hypothesized that older adults with polypharmacy and increased hospitalization rates would have more genes associated with altered drug metabolism or lack of sensitivity to certain drugs than those with fewer hospitalizations.
The researchers performed pharmacogenetic testing to identify five such genes — CYP2C19, CYP2C9, VKORC1, CYP2D6, CYP3A4/5 — in older adults with polypharmacy. The study included six seniors who had been admitted to the hospital at least three times over the past two years and six age-matched controls who had fewer hospitalizations. Both groups had an average age of 77 years, and were taking an average of 14 medications.
In the higher hospitalization group, each of the participants had at least one of the mutations, and half had more than one. None of the controls had any of the mutations.
“Although this was a very small pilot study, the findings suggest that routine testing for these gene variants could improve health outcomes for older adults taking multiple medications,” according to Joseph Finkelstein, MD, PhD, director of the Center for Bioinformatics and Data Analytics in Oral Health at the Columbia University College of Dental Medicine, associate professor of health informatics in dentistry at Columbia University Medical Center, and lead author of the paper. “In dentistry, for example, pharmacogenetic testing could be part of a personalized approach in which clinicians select pain medications that are most effective and least risky for each patient.”
Pharmacogenetics aligns current and future medications with each persons unique genetic profile.
For more information on pharmacogenetics in the field of aging services, contact: PGx Medical, info@pgxmed.com or 405-509-5112
source: Sciencedaily.com
by PGx Medical | Nov 28, 2016 | Uncategorized
We value our partnership with LTC Communities across the country and it is always great to get feedback on how pharmacogenetics has impacted their residents, families and staff.
Gary Clason, RN/BSN/DON Fountain View Manor
We did a pharmacogenetic test (aka DNA testing) on one of our residents who is a 70 year old female with severe mental disabilities. She has expressive and receptive aphasia, she cannot communicate in any way other than pain. She was taking Tylenol #3 TID routine. Her pharmacogenetic test came back that she is a rapid metabolizer of codeine. So the doctor changed her pain medication to hydrocodone TID.
The change we saw nearly immediately with this resident was in her activity level. With Tylenol #3 she was sleeping for an hour after taking her routine dose. This impacted her sleep at bedtime. When changed to hydrocodone she began ambulatory more after medication administration. This gave her exercise throughout the day which made her tired at bedtime which lead to better sleep. ~Gary Clason
For more information on pharmacogenetic testing, contact: PGx Medical, info@pgxmed.com or 405-509-5112
by PGx Medical | Nov 23, 2016 | Uncategorized
Thanksgiving is a time most of us spend with family to reflect and share. But what happens if a family member suffers from short-term memory loss?
In a recent article from Waugh Consulting, it gives some simple tips that can help you have an enjoyable, memorable Thanksgiving.
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1. Dates often are confusing for your loved one so refrain from referencing the date with comments such as “Next Thursday is Thanksgiving,” or “Only a week until Thanksgiving.”
2. Large groups are very stressful so consider meeting in a common area but have a place where the person can get away from it all for a while.
3. The eyes have it! Watch their eyes and they will tell you when the event is becoming too overwhelming for them. Their eyes will lose their sparkle and you will see them staring off into space. Time for a retreat from the group.
4. Bring up good Thanksgiving memories by using the phrase “I was thinking about ….” and “Mom’s pineapple dessert was always my favorite!” while refraining from using the phrase “Do you remember….”.
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Wishing you and yours a very happy and memorable Thanksgiving!
PGx Medical
www.pgxmed.com
info@pgxmed.com
405-509-5112
by PGx Medical | Nov 15, 2016 | Uncategorized
More and more patients are being screened to help cut out ineffective medicine and avoid harmful drug interactions
More patients are taking five or more prescription medications at once, putting them at risk for side effects and drug interactions. Amid concern about the potential harm of taking too many drugs, more doctors are deprescribing, getting patients off prescriptions that are no longer necessary.~WSJ
According to a recent article in the Wall Street Journal, nearly 40% of patients in their 60s take more than five medications.
“What was good for you once might not be as good for you now,” says Cara Tannenbaum, a geriatrician and the scientific director of the Institute of Gender and Health at the Canadian Institutes of Health Research in Montreal. “On a regular basis, patients should be asking their health-care providers, ‘Is this still the right drug for me, and if not, what other drug or nondrug therapies are safer and equally effective?’ ”
Dr. Tannenbaum and pharmacist Barbara Farrell have developed a website, deprescribing.org, which is maintained by the Canadian Deprescribing Network, a group that includes health professionals, policy makers and patient advocates. The site, used by doctors in both the U.S. and Canada, provides information to help patients determine if they should consider stopping certain medications that may be unnecessary or cause harm, including a common medication for heartburn or reflux called a proton pump inhibitor and certain diabetes drugs that increase the risk for low blood sugar.
Medication use can start to pile up in middle age or earlier, especially in patients being treated for diabetes, heart disease or cancer. People may see different doctors who don’t coordinate care with each other. Soon, they are in a situation known as polypharmacy, defined as five or more drugs.
The body processes many drugs less efficiently as it ages, leading to problems with long-term medications. Statins, prescribed to control cholesterol, may not be needed over age 75, and they can cause muscle weakness and increase the risk of falls.
The American Geriatrics Society last year updated its Beers Criteria, a list of 40 medications or classes of drugs that are potentially inappropriate for older adults. An expert panel is working on an update for 2018.
“The goal is to keep patients as healthy as possible on the least number of medications.”
VIDEO: When Patients Take Too Many Pills, Doctors Deprescribe
Pharmacogenetics is a tool used by doctors across the country to provide evidence-based results on how a person metabolizes medications. This simple swab of the cheek is a guide to help clinicians with current medication regimen, as well as a roadmap for future medications.
“Knowing that a medication doesn’t have the ability to give a patient therapy is a great way to deprescribe. You have evidence that person is not receiving therapy because their body does not metabolize that particular drug the way the drug manufacturer intended you to – making it easier to deprescribe, or discontinue that medication,” said Clay Bullard, President of PGx Medical a pharmacogenetic consulting firm headquartered in Edmond, OK.
“We work within the field of aging services across the country educating them on the benefits and value pharmacogenetics brings to not only the patient, but the caregiver and the community when dealing with a nursing home or assisted living facility, Our job is to be experts in the field of pharmacogenetics and then educate and help implement the test in communities, clinics and pharmacies across the U.S.”
Pharmacogenetics is fully reimbursed by Medicare B and in select states, Medicaid. As stated in the WSJ article, by eliminating multiple drugs, you help reduce the chance of falls, drug interactions, and many other clinical concerns.
For more information about pharmacogenetic testing, contact:
PGx Medical
info@pgxmed.com or 405-509-5112
or go to www.pgxmed.com
Read entire article at WSJ.com
More Patients Are Taking More Prescription Medications At Once
by PGx Medical | Nov 4, 2016 | Uncategorized
Avoiding the administration of unnecessary drugs is critical to maintaining a resident’s highest practicable health and well-being, and the basis of F-329.
Sonja Quale, VP and CCO at Pharmerica
In a recent article in McKnights Long Term Care News, Sonya Quale, Vice President and CCO at Pharmerica gets in-depth on F-329 citations.
According to CASPER (Certification And Survey Provider Enhanced Reports), 21.6% of facilities were cited for a F-329 deficiency based on a March 1, 2016, report of data on the last standard health survey of active SNF/NF. That is the sixth highest in the number of citations. In this blog, I’ll share certain facility risk factors for F-329 citation by surveyors, particularly when it comes to use of the highly scrutinized antipsychotic drugs.
F-329 states that each resident must receive only those medications necessary, in the doses and for the duration required, to treat specified conditions after consideration of non-pharmalogical interventions. A resident’s drug regimen must be managed and monitored to promote his or her optimal mental, physical and psychosocial well-being, with particular attention paid to minimized adverse consequences or worsening symptoms.
In addition, F-329 states that antipsychotic drugs should only be given to residents who have adequate indication for its use, and that residents who use antipsychotic drugs must receive gradual dose reductions to determine if the indication for use can be managed at a lower dose or if the medication can be discontinued.
To ensure compliance with F329, a surveyor will seek to determine:
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Whether a resident is taking only those medications that are clinically indicated in the dose and for the duration to meet his or her assessed needs,; if non-pharmacological approaches were attempted when clinically indicated; and if gradual dose reductions were made for antipsychotics
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If comprehensive care plans reflect appropriate parameters for monitoring medications or mediation combinations that pose a risk of adverse consequences
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If a facility’s medication management system monitors the effectiveness of medications and evaluates worsening signs or symptoms or change in condition that could be related to the medication
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Whether the pharmacist performs monthly medication regimen reviews
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How a center identifies and reports irregularities
Revisions to guidance in the State Operations Manual issued in 2016 highlight the importance of reducing the risk of psychosocial harm associated with noncompliance with specific regulations. Recommendations include:
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Using non-pharmacological approaches for distressed behaviors
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Focusing on identifying underlying causes of delirium, a common adverse consequence from medications, as well as other factors such as electrolyte imbalance and infection
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Monitoring of psychosocial functioning that can result from a medication side effect
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Watching for signs, symptoms or conditions that may be associated with medications, such as apathy, lethargy, and mental status changes
Moreover, significant additions to the guidance noted in the deficiency categorization section of F329 include:
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Failure to recognize that symptoms of increased confusion and that newly developed inability to do activities of daily living resulting in hospitalization are the result of excessive doses of antipsychotic given without adequate clinical indication
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Failure to recognize the continuation of an antipsychotic, originally prescribed for delirium, has caused significant changes in the resident’s behavior from baseline
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Failure to re-evaluate continuation of an antipsychotic originally prescribed for acute delirium which resulted in significant side effects
Source: McKnights Long Term Care News
One medical plan of action is to implement a medication management tool, via pharmacogenetic testing into your community for residents with medical necessity. This fully reimbursed diagnostic is a simple swab of the cheek that provides clinical caregivers an individualized report aligning current and future medications with each persons unique genetic profile. Right drug, right dose, right person. This allows individualized treatment and evidence-based reports to guide you in therapy for your residents.
For more information on how you can implement pharmacogenetics into your community, contact: PGx Medical, info@pgxmed.com or 405-509-5112.
