Definitions Used in the Medication Regimen Review (MRR) Process
Jeannine LeCompte, Compliance Research Specialist
It is important to have a proper understanding of the terms used throughout the Medication Regimen Review (MRR) process. CMS has provided precise definitions, which have been designed to allow the clear management of each resident’s medication regimen for effectiveness and safety.
“Adverse consequence” is a broad term referring to unwanted, uncomfortable, or dangerous effects that a drug may have, such as impairment or decline in an individual’s mental or physical condition or functional or psychosocial status. It may include various types of adverse drug reactions and interactions (e.g., medication-medication, medication-food, and medication-disease).
“Clinically significant” means effects, results, or consequences that affect or are likely to affect an individual’s mental, physical, or psychosocial well-being in one of the following ways: positively by preventing, stabilizing, or improving a condition or reducing a risk; or negatively by exacerbating, causing, or contributing to a symptom, illness, or decline in status. Any circumstance that does not require this immediate attention is not considered a potential or actual clinically significant medication issue for the purpose of the drug regimen review items.
“Dose” is the total amount/strength/concentration of a medication given at one time or over a period of time. The individual dose is the amount/strength/concentration received at each administration. The amount received over a 24-hour period may be referred to as the daily dose.
“Irregularity” refers to use of medication that is inconsistent with accepted standards of practice for providing pharmaceutical services, not supported by medical evidence, and/or that impedes or interferes with achieving the intended outcomes of pharmaceutical services. An irregularity also includes, but is not limited to, use of medications without adequate indication, and without adequate monitoring, in excessive doses, and/or in the presence of adverse consequences, as well as the identification of conditions that may warrant initiation of medication therapy.
“Medication Interaction” is the impact of another substance (such as another medication, herbal product, food or substances used in diagnostic studies) upon a medication. These interactions may alter absorption, distribution, metabolism, or elimination. These interactions may decrease the effectiveness of the medication or increase the potential for adverse consequences.
“Medication Follow-Up” is the process of contacting a physician to communicate an identified medication issue and completing all physician prescribed/recommended actions by midnight of the next calendar day at the latest.
“Contact with Physician” means communication with the physician to convey an identified potential or actual clinically significant medication issue, and a response from the physician to convey prescribed/recommended actions in response to the medication issue. Communication can be in person, by telephone, voice mail, electronic means, facsimile, or any other means that appropriately conveys the resident’s status.
