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OASIS E: New Rules for M2010 High-Risk Medications

Posted by Melissa Cott on Oct 28, 2020

Currently on OASIS D1 clinicians are required to teach patients on high risk medications at Start of care and Resumption of Care, per the OASIS question M2010 Patient/Caregiver High-Risk Drug Education. Medicare suggests referring to authoritative sources, such as the Institute for Safe Medication Practices, for a list of high risk medications.

Coming soon - on OASIS E - are (potentially) new assessment questions that identify the high risk medications on which Medicare wants patients to be taught.

Although only the draft version of OASIS E has been released (with the final version typically available during the M2010 High-Risk Medication Teaching Quiz & Answerssummer), it finally eliminates the confusion around which high-risk medications require teaching. They are opioids, hypoglycemics, antipsychotics, antiplatelets, antibiotics and anticoagulants.

ANTIPSYCHOTICS

Uses: treatment of psychoses, schizophrenia, schizoaffective disorder, personality disorder and bipolar disorder. 
Why they’re a high-risk drug: Common side-effects can be serious, including Parkinson’s-like symptoms, hyperprolactinemia, neuroleptic malignant syndrome, postural hypotension, arrhythmias, sedation, seizures, sexual dysfunction, type 2 diabetes mellitus, anticholinergic effects, dyslipidemia

Specific patient teaching

  • Antipsychotics affect people differently. 
  • Different antipsychotics medications may be prescribed to find the right one that can control symptoms
  • Contact the doctor if the medication is not working.
  • Don't stop taking antipsychotics suddenly.
  • Antipsyhi-risk-drugschotics can interact with other medications. Inform the doctor of all medicines being taken including homeopathic and other over-the-counter medications.

 

Common Antipsychotics: First generation (Typical): Benperidol (Anquil), Chlorpromazine (Largactil), Flupentixol (Depixol), Fluphenazine (Modecate), Haloperidol (Haldol), Levomepromazine (Nozinan), Pericyazine, Perphenazine (Fentazin), Pimozide (Orap), Promazine, Sulpiride (Dolmatil, Sulpor), Trifluoperazine (Stelazine), Zuclopenthixol (Clopixol)

Second generation (Atypical): Amisulpride (Solian), Aripiprazole (Abilify, Abilify Maintena), Clozapine (Clozaril, Denzapine, Zaponex), Risperidone (Risperdal & Risperdal Consta), Olanzapine (Zyprexa), Quetiapine (Seroquel), Paliperidone (Invega, Xeplion)

ANTICOAGULANTS

Uses: Prevention of blood clots.
Why they’re a high-risk drug: Anticoagulants can cause internal bleeding, symptoms of stroke and anemias.

Specific teaching

  • Be careful mixing medications. Some antibiotics and anti-fungal medications can make blood thinners more potent and increase the risk of bleeding.
  • Tell all health care providers, dentists, physicians, pharmacists that you’re taking blood thinners.
  • Always take anticoagulant as directed by the doctor. Don’t skip a dose and don’t double up. If a dose is missed, take it as soon as possible.
  • Watch for evidence of internal bleeding. Slow bleeding can cause fatigue, shortness of breath, pale skin color and black, tarry-looking stools. Rapid bleeding can cause stroke symptoms, abdominal and back pain.
  • Take precautions to minimize the risk of falls or trauma that could potentially cause significant bleeding.
  • Avoid alcohol.


Common Anticoagulants: Apixaban (Eliquis), Dabigatran (Pradaxa), Edoxaban (Savaysa), Enoxaparin (Lovenox), Heparin, Rivaroxaban (Xarelto), Warfarin (Coumadin)

ANTIBIOTICS

Uses: Treatment of bacterial infection
Why they’re a high-risk drug: Frequent and/or inappropriate use of antibiotics can cause bacterial or antibiotic resistance.

Specific teaching

  • Take entire prescription; do not stop when feeling "better" as this creates antibiotic resistance.
  • Report any adverse response or lack of improvement after 48-72 hr.


There are over 200 unique antibiotics. The most common are: amoxicillin, doxycycline, cephalexin, ciprofloxacin, clindamycin, metronidazole, azithromycin, sulfamethoxazole and trimethoprim, amoxicillin and clavulanate, levofloxacin

OPIOIDS

Uses: Treatment of acute pain
Why they’re a high-risk drug: Opioids are highly addictive, a growing problem throughout the United States. Overdose can cause respiratory depression and death. 

Specific teaching

  • Opioids are safest when used for three or fewer days to manage acute pain, such as pain that follows surgery or a bone fracture.
  • If opioids are needed for acute pain, work with the doctor to take the lowest dose possible, for the shortest time needed, exactly as prescribed.


Common Opioids

  • Oxycodone (OxyContin, Oxy, Percocet, Percodan, Roxicet, and Endocet)
  • Hydrocodone (Vicodin, Norco, Lortab, Lorcet, and Vicoprofen)
  • Codeine (found in combination medicines such as Tylenol #3 or Robitussin AC)
  • Hydromorphone (Dilaudid)
  • Morphine (MS Contin and Roxanol)
  • Fentanyl (Sublimaze, Subsys, Duragesic)


ANTIPLATELETS

Uses: Prevention of blood clots.
Why they’re a high-risk drug: Like anticoagulants, antiplatelets can cause internal bleeding, heavy bleeding or bruising.

Specific Teaching

  • Take antiplatelets exactly as prescribed.
  • ASA can bother the stomach and should be taken with food. Other antiplatelets can be taken with or without food.
  • Do not stop taking antiplatelets unless instructed by the doctor


Common Antiplatelets 

  • ASA - Acetylsalicylic acid (Aspirin, Asaphen, Entrophen, Novasen)
  • Clopidogrel (Plavix)
  • Prasugrel (Effient)
  • Ticagrelor (Brilinta)


HYPOGLYCEMICS

Uses: Treatment of diabetes
Why they’re a high-risk drug: Hypoglycemics can cause low blood sugar resulting in visual disturbances, loss of consciousness, seizures, death

Specific Teaching

  • A meal should be consumed within 30 minutes after administering regular insulin
  • Having a strict insulin schedule is essential for keeping blood sugar levels within a healthy range.
  • A doctor may prescribe insulins that act at different speeds to keep a person’s blood glucose levels more consistent.
  • People at risk of hypoglycemia should wear a medical bracelet stating their type of diabetes, plus other necessary information, such as whether they control their condition with insulin.
  • These bracelets provide information to first aiders and medical professionals in case a person becomes conscious.


Hypoglycemics

Oral Hypoglycemic Medications: Sulfonylureas (glipizide, glyburide, gliclazide, glimepiride), Meglitinides (repaglinide and nateglinide), Biguanides (metformin), Thiazolidinediones (rosiglitazone, pioglitazone), α-Glucosidase inhibitors (acarbose, miglitol, voglibose), DPP-4 inhibitors (sitagliptin, saxagliptin, vildagliptin, linagliptin, alogliptin)

Short-acting insulin: regular insulin (Humulin and Novolin)

Rapid-acting insulins: insulin aspart (NovoLog, FlexPen, Fiasp), insulin glulisine (Apidra), insulin lispro (Humalog)

Intermediate-acting insulin: insulin isophane (Humulin N, Novolin N)

Long-acting insulins: insulin degludec (Tresiba), insulin detemir (Levemir), insulin glargine (Lantus), insulin glargine (Toujeo),

Combination insulins: NovoLog Mix 70/30 (insulin aspart protamine-insulin aspart), Humalog Mix 75/25 (insulin lispro protamine-insulin lispro), Humalog Mix 50/5

Antipsychotics: Do they do more harm than good? (n.d.). Retrieved October 28, 2020, from https://www.medicalnewstoday.com/articles/317296
Cherney, K. (2020, June 17). List of Common Diabetes Medications. Retrieved October 28, 2020, from https://www.healthline.com/health/diabetes/medications-list
Insulin therapy: Side effects, myths, and tips. (n.d.). Retrieved October 28, 2020, from https://www.medicalnewstoday.com/articles/323387
Omudhome Ogbru, P. (2019, October 28). Insulin for Diabetes Treatment: Facts about Side Effects. Retrieved
October 28, 2020, from https://www.medicinenet.com/insulin_for_diabetes_treatment_types_side_effects/article.htm
Treatment. (n.d.). Retrieved October 28, 2020, from https://www.rchsd.org/health-articles/the-danger-of-antibiotic-overuse/