Unnecessary or Excessive Drug Dosing Cheat Sheet by Davidpol
Unnecessary or Excessive Drug Dosing
common medical dosing healthcare drug unnecessary excessive
A. Unnecessay Drugs Excessive Dose
1. Sedative/ hypnotics or anxiolytics
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
ABSENCE OF ADEQUATE DOCUMENTED SUPPORTING DIAGNOSIS OR CLINICAL SYMPTOMS FOR
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.
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