The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists
-
Outline the key points and list the criteria for compliance with the new Centers for Medicare & Medicaid Services (CMS) pain management at F-Tag 309. ⋯ In March 2009, CMS implemented revised guidelines for long-term care surveyors at F-Tag 309, Quality of Care, including a new general investigative protocol and pain-management guidance. While the regulations have remained the same, the way surveyors interpret pain management has changed. By understanding the criteria surveyors will use to determine F-Tag 309 deficiencies, consultant pharmacists can educate other interdisciplinary team members to improve pain management practices in long-term care.
-
Summarize practical strategies for recognizing and assessing pain in the long-term care population, particularly for cognitively impaired residents. ⋯ Pain that is under-recognized and undertreated can result in significant physical and social disability in the elderly long-term care population. Proper assessment of pain is needed to diagnose and determine an appropriate and individualized treatment plan for each resident. Consultant pharmacists play critical roles as medication experts and members of the long-term care interdisciplinary team that can assist other team members in the assessment, treatment, and management of pain in older adults.
-
Evaluate the efficacy and safety of pharmacological pain management treatments to minimize adverse events and optimize pain relief. ⋯ Pain is a common problem among elderly long-term care residents and is vastly undertreated. Even when pain medication is prescribed, often residents do not receive the most appropriate drug, or prescribers fail to adjust the dose and frequency of administration to tailor therapy to the individual's compromised physiology and needs. This places elders at risk, for not only unnecessary suffering, but also for drug toxicity. Consultant pharmacists are in a key position to identify underuse and inappropriate use of analgesic drugs and assist prescribers with individualizing each resident's medication regimen to provide optimal therapeutic outcomes.
-
Review Comparative Study
The effect of sevelamer hydrochloride and calcium-based phosphate binders on mortality in hemodialysis patients: a need for more research.
To review phosphate-binder choice and mortality in hemodialysis patients. ⋯ Clinical trials relating the effect of phosphate-binder choice on cardiovascular disease and mortality in hemodialysis patients, judged to be pertinent by the authors, were selected for discussion. DATA SYNTHESIS/CONCLUSIONS: The Renagel in New Dialysis (RIND) extension study and the Dialysis Clinical Outcomes Revisted (DCOR) study were the first clinical trials to compare the effects of calcium-based phosphate binders and sevelamer hydrochloride on mortality in hemodialysis patients. Based on the results of these and other studies evaluated, it is still unclear if sevelamer hydrochloride has a survival benefit in hemodialysis patients over calcium-based phosphate binders.
-
Fentanyl transdermal system is indicated for the management of persistent, moderate-to-severe chronic pain that requires continuous opioid administration for an extended period of time and cannot be managed by other means such as nonsteroidal analgesics, opioid combination products, or immediate-release opioids. The Institute for Safe Medication Practices and other patient safety advocates have long been concerned that transdermal fentanyl is often prescribed, dispensed, and administered without proper consideration of patient selection criteria, starting-dose recommendations, contraindications, dose adjustment recommendations, and safe administration procedures. This article will highlight errors that may arise during the use of fentanyl patches and provide risk-reduction recommendations for consultant pharmacists to address the potential for error and patient harm.