CMS requires that certain data be collected for residents in a long-term care facility. This information, known as the Minimum Data Set (MDS) is a collection of resident specific basic physical, functional, and psychosocial information. In addition to the MDS, the facility should also complete the Care Area Assessment (CAA) process. CAAs are triggered responses to items coded on the MDS specific to a resident’s possible problems, needs or strengths (1). There are currently 20 CAAs, 15 of which may be directly impacted by medication-related issues.

CAAs that can be Triggered by Medications

1. Activities

2. Activities of Daily Living

3. Behavioral Symptoms

4. Communication

5. Dehydration/Fluid Maintenance

6. Delirium

7. Dental Care

8. Falls

9. Mood State

10. Nutritional Status

11. Pressure Ulcers

12. Psychosocial Well Being

13. Psychotropic Medication Use

14. Urinary Incontinence and Indwelling Catheter

15. Visual Function

The consultant pharmacist has an instrumental role as a part of the interdisciplinary care team to help improve resident quality of care. A consultant pharmacist review of the MDS and CAA triggers can optimize the monthly medication regimen review. A consultant pharmacist can use the CAA triggers to identify residents that may require an additional review of medication therapy. For example, residents that have triggered for weight loss should receive a medication review for therapy that may suppress appetite. In addition, using the MDS and CAA information can also help improve the facility quality assurance assessment and improvement procedures. Identifying facility patterns can improve medication utilization.

1. Centers for Medicare and Medicaid Services Long-Term Care Facility Resident Assessment Insturment3.0 User Manual. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/MDS-30-RAI-Manual-V113.pdf