CMS Medication Administration and Management: IV Medication, Blood Administration and Safe Opioid Use

This program will discuss the CMS standards on medication administration, IV medication, including required hospital policies, ISMP IV Push guidelines, blood transfusion and safe opioid use. The CMS standards on the care of the patient receiving opioids also apply to critical access hospitals.

In addition to CMS requirements, the following are also covered: CDC opioid guidelines, Joint Commission pain management guidelines, and AHRQ on Acute Pain. This program will include a discussion of recommendations and guidelines on the use of opioids from various other organizations including the HHS National Action Plan for ADR Prevention, AMA, and Institute for Healthcare Improvement (IHI).

This program will cover the Nursing Conditions of Participation as they relate to medication and blood administration – patient assessment and monitoring, staff education, and adverse medication events.  CMS PACU standards will be discussed briefly, including the need for patient monitoring for patients receiving opioids. 

Staff education on safe opioid use is essential and includes an assessment of the patient to determine who will be at risk for an adverse event from the use of IV opioids including PCA. Staff must be educated on the side effects and how to recognize them.

• Describe the three different timeframes in which all medications must be administered
• Recall that CMS has required policies and education requirements on medication administration and safe opioid use
• Discuss CMS requirements to ensure nurses are competent when giving IV medications or blood transfusions
• Recall that the CDC issued opioid prescribing guidelines.

• Introduction
• CMS Manual
• CoPs on Nursing and Medication Administration
• Preparation and administration of drugs
• Orders for drugs and biologicals
• Safe injection practices
• ISMP guidelines on IV Push medication
• ISMP guidelines on sterile compounding
• Timeframes for administration
• IV Medication
• High-alert medication
• Staff training and competencies
• Patient risk factors
• Need for physician orders
• Use of opioids and IV opioids
• Risk factors and patient monitoring
• Policies and procedures
• Examples of sedation scales
• Blood transfusions
• PACU and Opioids
• Safe opioid use
• Joint Commission guidelines/standards
• CDC opioid guidelines
• AHRQ Opioids and Treatment for acute pain
• National Action Plan – ADR prevention.

Appendix and Resources

• Chief nursing officer
• All nurses with direct patient care
• Nurse managers/supervisors
• Nurse educator
• Pharmacists
• Director of Pharmacy
• Compliance officer
• Chief of medical staff
• Risk manager
• Patient safety officer
• Senior leadership
• PI director
• Joint Commission coordinator
• Regulatory officers
• Chief operating officer
• Physicians
• Education department staff
• Audit staff
• Others are responsible for compliance with hospital regulations, including documentation compliance.