VT4 Presentations

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William Vaughan
First Do No Harm: Managing High Risk Drugs in Long Term Care

Subject: Safe and effective geriatric medication management involves much more than simply administering “what the doctor ordered”. Drugs used to treat both chronic and acute conditions in the elderly provide powerful benefits but also carry significant risk. Long term care providers have an obligation to partner with the resident, their surrogate decision makers, the prescriber, pharmacy staff and the entire interdisciplinary team to identify and minimize those risks. This presentation, through the use of case studies and group discussion, will examine classes of drugs that are considered high risked when administered to the elderly. Emphasis will be placed on drug classes undergoing current scrutiny such as antibiotics, psychotropics, and opioids. Lastly, a resident-centered approach to managing such drugs will be highlighted.


1. Identify two age related physiologic changes which increase the risk of an adverse drug reaction.
2. List three classes of drugs considered high risk when used in the elderly.
3. Describe the concept of the “prescribing cascade”.
5. Describe two nonpharmacological approaches to symptom management.

QAPI and Medication Management: Leveraging the Resources and Expertise of Your Pharmacy

Summary: 2019 marks the full implementation of the ‘mega rule”, including new requirements related to quality assurance and performance improvement. With a regulatory mandate to focus on high-risk, high-volume or problem-prone areas, many facilities will prioritize medication management when developing performance improvement activities. This presentation will highlight how facilities can utilize the unique resources and expertise of their pharmacy to complying with QAPI regulations. The use of pharmacy generated data to identify, analyze and track medication trends along with evidence based practices to optimize geriatric medication management will be discussed in detail.


1. Describe the elements of an adverse event as defined in the CMS guidance to surveyors under F 867.
2. Identify two process data metrics useful in monitoring performance improvement activities related to medication management.
3. Identify two outcome data metrics useful in determining the effectiveness of performance improvement activities related to medication management.
4. Discuss two evidence based practices which reduce the risk of adverse drug reactions in the geriatric resident.