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Unnecessary or Excessive Drug Dosing Cheat Sheet by

Unnecessary or Excessive Drug Dosing
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A. Unnecessay Drugs Excessive Dose

1. Sedative/ hypnotics or anxiol­ytics
2. Antips­ych­otics.
3. Antide­pre­ssants.
4. Use of inappr­opriate sedative/ hypnot­ic/­anx­iol­ytics.

B. Excessive Duration of Drug Therapy

5. Stop order medica­tions (antib­iotics, treatm­ents, etc.).
6. Sedative/ hypnotics/ anxiol­ytics (See Table).
7. Antibi­oti­c/s­teroid ophtha­lmics use over 21 continuous days.
8. H2 receptor antago­nists (stomach ulcer meds) used above mainte­nance dose > 3 months w/o attempt to decrease except in Zollin­ger­-El­lison syndrome or gastro­eso­phageal reflux disease
9. PRN drug admini­stered daily for more than 30 days.

Inadequate Monitoring of

10. Antihy­per­tensive drugs without blood pressure recorded at least weekly .
11. Antico­agulant therapy without monthly clotting test results.
12. Cardio­active drugs without recorded pulse rate or rate outside 50 to 100 BPM
13. Insulin or oral hypogl­ycemics without urine sugar test weekly or blood sugar test at least every 60 days.
14. Hematinics without RBC assessment during first 30 days of therapy.
15. On Mandel­amine or Hiprex without urine pH within 30 days of treatment or if pH is above 6 on continuous therapy.
16. Diuretics without serum K+ level within 30 days of therapy and regularly therea­fter.
17. On diuretics and Lanoxin without serum K+ level within 30 days of therapy and at least every 6 months therea­fter.
18. Non-st­eroidal anti-i­nfl­amm­atory drugs (NSAID) contin­uously without at least one hematocrit or hemoglobin level 30 days after therapy
19. Systemic use of aminog­lyc­oside antibi­otics without serum creatinine determ­ina­tion.
20. Use of antips­ych­otics without AIMS test at initiation and every 6 months of therapy.
21. Use of Tegretol (carba­maz­epine) without CBC at start of therapy and regularly therea­fter.
22. Patient on antico­nvu­lsants who has seizures repeat­edly.
23. Receiving thyroid drug has not had an assessment of thyroid function.
24. Use of chronic UTI antibi­otics if UA not been done 30 days after TX initiated.

D. Absence of Supporting Diagnoses or Symptoms


25. Nitrof­ura­ntoin (Macro­dantin, Furada­ntin) for other than UTI and BUN or serum creatinine level must be recorded.
26. Use of Lanoxin without docume­ntation of an approp­riate of Dx of: CHF, AT.FIB, AT.FLUT, or PSVT.
27. Use of antich­oli­nergic drugs with antips­ych­otics in absence of recorded EPS.
28. Antips­ychotic drugs use without approp­riate Dx.
29. Vitamin B12 in absence of Dx of pernicious anemia.
30. Any drug without specific reason or indica­tion.

E. Duplicate Therapy

31. 3 or more analgesics used concur­rently except for intrac­table pain.
32. Use of 2 or more laxatives (excluding softeners and bulk agents) concur­rently. Sequential use accept­able.
33. Use of 3 or more laxatives (excluding softeners and bulk agents) concur­rently. Sequential use acceptable
34. Use of 2 or more NSAIDS concur­rently

F. Antips­ychotic Drug Use

35. Initiation of antips­ychotic drugs without docume­ntation of an acceptable Dx or if only for an inappr­opriate reason.
36. Concom­itant use of more than one antips­ych­otic.
37. Any resident on an antips­ychotic drug without: gradual dose reduction, drug holidays, or behavioral progra­mming unless contra­ind­icated.
38. Charting error.
39. Drug has not been charted recently - revaluate need.
40. Patient discomfort / undesired blood levels due to crushed solid dosage.
41. Not reimbu­rsable by Medicaid.
42. Miscel­laneous

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