CMS Mega-Rule Update and the Status of Pharmacy-Related Deficiencies in Nursing Homes

Abstract

The scope, frequency, and nursing home characteristics associated with pharmacy-related deficiency citations following the Centers for Medicare and Medicaid Services 2016 “Mega-Rule” update are described. A retrospective analysis of data from Nursing Home Compare and LTCfocus.org was conducted on pharmacy-related deficiencies (including pharmacy services, drug regimen review, unnecessary medications, medication errors, and labeling/storage). The most commonly cited pharmacy-related deficiencies ( N = 11,678) were related to labeling/storage (comprising 25.1% of pharmacy-related deficiencies), unnecessary psychotropic medications (20.5%), and routine pharmacy services (16.8%). In multivariable analysis, nursing home characteristics significantly associated with receiving any pharmacy-related deficiency included less geographic competition (adjusted odds ratio [aOR]: 0.68), registered nurse hours (aOR: 0.66), occupancy (aOR: 0.67), for-profit status (aOR: 1.27), and Midwest (aOR: 1.50) or West (aOR: 2.95) location. Given the frequency of pharmacy-related citations and the lack of standardization in pharmacists’ roles in nursing homes, further research is needed to better understand how pharmacist services can affect inspection compliance.