Assisted Living Medication Management: Medication Monitoring

Medication monitoring addresses questions like:

  • Is the medication working? To answer that question, the reason for using the medication must be known; the goals of treatment must be known; and data must be collected. In some cases facility staff may play a critical role in determining if a medication is working. For example, when a medication is being used for pain with the goal to reduce pain, staff at the facility can collect data related to the pain the resident may be experiencing. That data can be used to determine if different or more medication may be needed. In some cases, the data that is collected may be more isolated like a blood level for the medication. In these cases medication monitoring for effectiveness may be in the hands of the physician. It is important for facility staff to know what a medication is being used for and the goals for treatment. Often times the facility will need to have a role in collecting data so that a determination of the medication’s effectiveness can be made.
  • Is the medication causing adverse effects? To answer this question, common potential adverse effects for medications need to be known. Facility staff who know some of the potential adverse effects of medications can have a vital role in notifying physicians, pharmacists etc. that the resident may be experiencing a medication adverse effect. Some adverse effects are easily identified like a rash or hives. Other medication adverse effects may be subtle like increased confusion or less sleep. Facility staff generally will know a resident very well and can identify potential adverse effects and notify appropriate individuals so that an intervention can be made.
  • Are medications that a resident takes contributing to falls? Falls can occur for many reasons and medications may increase the risk of falls. For example, some medications may lower blood pressure, causing dizziness when a resident rises quickly from a sitting or lying position. This dizziness may cause the resident to fall. Another example is a diuretic (water pill), which results in more frequent urination. A resident who is weak may attempt to get up and go to the bathroom independently, which may result in a fall.

Relevant Regulations

Community-Based Residential Facility (CBRF):
Wis. Admin. Code § DHS 83.37(1)(e)
Wis. Admin. Code § DHS 83.37(1)(h)
Wis. Admin. Code § DHS 83.37(1)(i)
Wis. Admin. Code § DHS 83.37(1)(l)

Residential Care Apartment Complex (RCAC):
Wis. Admin. Code § DHS 89.13(22)

Resources

Medication Monitoring for Falls

Medication Monitoring and Dementia

Using psychotropic medications for treating behaviors of dementia is not the standard of care in most instances. In most cases using other methods to address behaviors are safer and more effective. The following are websites to help avoid medications but if medications are used how to monitor.

FAQs

1. In a CBRF who can do the medication review?

Medication reviews can be done by a pharmacist or a physician at least annually. For required psychotropic medication reviews that can be done by a pharmacist, physician, or registered nurse. For the monthly as needed psychotropic medications an administrator or qualified designee can review as needed use of medications to ensure protocols followed.

2. How do we document medication reviews?

In a CBRF medication reviews are required annually, quarterly and monthly in some circumstances. For these reasons a facility should be documenting in a manner that shows these reviews were completed within the appropriate time frames and that the required information has been reviewed. For example, for psychotropic medications you must review if desired response has been obtained. Therefore documentation may include a note that various records were reviewed and observations made to show that the reviewer looked at the desired responses quarterly.

Last Revised: September 10, 2019