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MDS 3.0 Section N - Coding Medications
The intent of the items in this section is to record the number of days, during the last 7 days (or since admission/reentry if less than 7 days) that any type of injection, insulin, and/or select oral medications were received by the resident.
Code medications according to a drug's pharmacological classification, not how it is used. For example, oxazepam may be used as a hypnotic, but it is classified as an antianxiety medication. It would be coded as an antianxiety medication.
Include any of these medications given to the resident by any route (e.g., PO, IM, or IV) in any setting (e.g., at the nursing home, in a hospital emergency room) while a resident of the nursing home.
Code a medication even if it was given only once during the look-back period.
Count long-acting medications, such as fluphenazine decanoate or haloperidol decanoate, that are given every few weeks or monthly only if they are given during the 7-day look-back period (or since admission/reentry if less than 7 days).
Combination medications should be coded in all categories that constitute the combination. For example, if the resident receives a single tablet that combines an antipsychotic and an antidepressant, then both antipsychotic and antidepressant should be coded.
While assuring that only those medications required to treat the resident's assessed condition are being used, it is important to reduce the need for or maximize the effectiveness of medications for all residents. Therefore, as part of all medication management, it is important for the interdisciplinary team to consider non-pharmacological approaches. Educating the interdisciplinary team as well as facility consultant providers about non-pharmacological approaches in addition to and/or in conjunction with the use of medication may minimize the need for medications or reduce the dose and duration of those medications.
Section N - Coding Medications Youtube Video
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