Nursing Home Journal IV, Unnecessary Medications - DOC

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					                  Nursing Home Journal IV, Unnecessary Medications
                   Centers for Medicare and Medicaid Services (CMS)
                             Satellite Broadcast and Webcast

                            Friday December 15, 2006
                         Time frames (1:00-2:30 PM) EST

This satellite broadcast and Webcast will provide for, State Agency surveyors, an overview
of changes to the tag F329, Unnecessary Medications.


The purpose of today‟s program is to provide information for CMS Regional Office
Surveyors and State Survey Agency surveyors on the revised interpretive guidelines for
F329 Unnecessary Medication.


After viewing this program, participants will be able to:
 Discuss the changes in the guidance at F329
 List the key medication management considerations when evaluating a resident's
   medication regimen
 Describe the investigative protocol that couples F329 Unnecessary Medications and F428
   Medication Regimen Review.

Target Audience
CMS Central and Regional Office staff, State agencies, Provider Organizations


Moderators: Nicole Brandt and Beverly Cullen

Participants: Cynthia Best, Sarah Green Burger, Loriann DeMartini, Doug Englebert,
Jeanne Jackson, Jeri Jackson, Steve Levenson, Carla Saxton McSpadden, Todd Semla,
Matthew Wayne

Registration and Viewing Instructions
Individual and Site registration is available today. To obtain CEUs for viewing the training
program you must go to the CMS website. For individual and site registration and viewing
instructions go to:

Continuing Education Units (CEUs)
The Centers for Medicare & Medicaid Services has been reviewed and approved as an
Authorized Provider by the International Association for Continuing Education and Training
(IACET). To obtain CEUs for viewing the training program you must go to the CMS
website .

Webcast Information
This program will have a live Webcast and will be available for viewing up to one year
following December 15, 2006 at

Satellite Technical Specifications
This broadcast will be available on C and Ku Digicipher bands. Specific satellite technical
specifications will are available at or can be obtained by
calling 1-800-401-9387.

Handouts( if any) for this broadcast will be available at the following website after December
15, 2006 at


                    Nursing Home Journal IV, Unnecessary Medications
                             Webcast and Satellite Broadcast
                               Friday, December 15, 2006
                                  (1:00-2:30 PM) EST

On Friday, December 15, 2006 (1:00-2:30 PM) EST), the Center for Medicaid and State
Operations, Division of Nursing Homes will sponsor a live Webcast and satellite broadcast
entitled “Volume 4, Nursing Home Journal: Unnecessary Medications.” This broadcast
is designed to provide surveyors and providers with information about the new interpretive
guidance for F329, Unnecessary Medications, as well as a new investigative protocol and
severity guidance.

                                  Presenters and Topics

Time (EDT)           Topic                             Presenter
1:00 – 1:20 p.m.     Welcome and Introduction to      Beverly Cullen, Nicole Brandt
                     the new F329 Unnecessary         Thomas E. Hamilton, Director Survey
                     Medication Guidance              and Certification Group, CMS

1:25 -- 1:45 p.m. Surveyor Perspective of F329        Beverly Cullen and Federal and State
                                                      agency surveyors Loriann DeMartini,
                                                      Doug Englebert, Jeri Jackson

1:45 -- 2:00 p.m.    Key Medication Management        Nicole Brandt, Beverly Cullen and CMS
                     Domains                          expert panel members: Steve Levenson,
                                                      Carla Saxton-McSpadden, Todd Semla,
                                                      Jeanne Jackson, Matthew Wayne

2:00 -- 2:15 p.m.    Provider perspective of F329     Beverly Cullen, Nicole Brandt and CMS
                                                      expert panel members Cynthia Best and
                                                      Carla Saxton-McSpadden

2:15 -- 2:30 p.m.    Medical Director perspective     Nicole Brandt and Matthew Wayne,
                     of F329                          Steve Levenson, Loriann DeMartini,
                                                      Doug Englebert, Jeri Jackson

2:30 -- 2:40 p.m.    Advocacy perspective of F329 - Nicole Brandt, Beverly Cullen, and
                     Implications for Residents     expert panel member, Sarah Greene

2:40 – 2:45 p.m.     Conclusion                       Nicole Brandt, Beverly Cullen

Faculty Biographical Information

Cynthia Best, RN, BSN, BC, RAC-C serves as the Director of Clinical Support and
Compliance/HIPAA Privacy Officer of Provena Senior Services. In this position, Ms. Best
provides clinical, survey, policy, compliance, HIPAA, and education expertise to the Provena
Senior Services facilities. Ms. Best has over 18 years experience in long term care and has
been a Director of a hospital based SNF unit, a Program Director for Adult Day Care, a
Medicare Case Manager, and a MDS Coordinator. In 2005, Ms. Best served as Contributor
to AMDA Urinary Incontinence Clinical Practice Guideline. Ms. Best chairs the MDS
Coordinator Council and Provena‟s Community Living Adult Board; and is a member of the
Senior Service Board, Provena Senior Services Quality Committee, and the Provena Health
Quality Performance Review/Corporate Responsibility Liason. She is also the Provena
Senior Services nursing leader for the DVT initiative, the nursing philosophy initiative, and
the palliative care initiative. Ms. Best is also currently earning her master's degree in Health

Nicole Brandt, PharmD, BCPP, CGP, FASCP Associate Professor Geriatric
Pharmacotherapy, Director of Clinical and Educational Programs at the Peter Lamy Center
on Drug Therapy and Aging, Department of Pharmacy Practice and Science, University of
MD School of Pharmacy. She is currently working with the Centers of Medicare and
Medicaid Services as a Special Technical Director in the Long Term Care Division focusing
on policies and regulations affecting medication management and pharmacy services in long
term care. She has been awarded 2004 Young Pharmacist Award in Maryland and 2002
Pharmacist of the Year for the MD State ASCP Chapter as well as receiving Human Health
Care Pharmacy Recognition Award for pharmacists who provide services to the betterment
of Alzheimer‟s patients and families.

Sarah Greene Burger, RN-C, MPH, FAAN, is the former Executive Director of The
National Citizens‟ Coalition for Nursing Home Reform (NCCNHR). In that capacity and as
Associate for Program and Policy, she helped build a coalition that focused Congressional
attention on important consumer issues: reducing physical and chemical restraint use and
malnutrition and dehydration. In 1997, she brought NCCNHR‟s consumer minimum staffing
standard to a consensus meeting called by the John A. Hartford Institute for Geriatric
Nursing, New York University. This minimum standard with enhancements and confirmed
by CMS research has now been recommended for nursing homes by the 2004 IOM report,
“Keeping Patients Safe.” She continues to work on developing and implementing policy on a
range of issues including nurse-aid training, nurse staffing, resident assessment, and care
planning. Ms. Burger has authored many consumer materials and guides and co-authored
two nursing home consumer books. Currently, she is also the coordinator for the Hartford
Institute‟s Coalition of Geriatric Nursing Organizations, whose 20,000 nurses seek to
improve the quality of care and life for elders wherever they receive their care.

Beverly Cullen, RN is a Nurse Consultant with CMS in the Division of Nursing Home
Branch for 8 years. Prior to coming to CMS, Beverly worked for over 17 years as a surveyor
and supervisor with the Minnesota Department of Health. At CMS, Beverly co-leads the
long term care survey process and specializes in quality of care. She was the co-project

officer for a contract to update interpretive guidance for surveyors and develop severity
guidance for several key tags from 2000 through September 2006. In 2005, Beverly received
the Thomas Stewart Founders Award of the National Pressure Ulcer Advisory Panel for her
work in the development of the F314 pressure ulcer guidance, which was released in
November, 2004.

Loriann DeMartini, PharmD, is Chief of the Pharmaceutical Consultant Unit for the
California Department of Health Services Licensing and Certification Program. She is
responsible for development of state regulations and legislative policies, supervision of
statewide field pharmaceutical consultants and serving as a liaison with advocacy
organizations and State and Federal governmental agencies. She has approximately 20 years
of experience in long term and acute care patient services, including psychiatric and alcohol
and drug dependence. She has been a speaker at numerous national, regional, and statewide
CMS training sessions, as well as state survey agencies and advocacy and professional
organizations. She is a faculty member for CMS Basic Hospital Survey training and is a
member of the American Society of Aging.

Doug Englebert, RPh, MBA, is a pharmacist in the Wisconsin
Department of Health and Family Services, Bureau of Quality Assurance, who served on the
CMS panel that participated in the development of the revised Pharmacy Services guidance.
He has practiced in a wide range of settings including acute care, managed care and long-
term care. Currently, Mr. Englebert provides leadership communicating, setting, and
enforcing pharmacy standards by conducting health care licensing and certification surveys,
providing consulting services, and conducting training for surveyors and providers in the
State of Wisconsin. Mr. Englebert has received a best practice award from the Association of
Health Facility Survey Agencies for a pharmacy newsletter that has been used by surveyors
from multiple states.

Jeanne Jackson, MD, is a Geriatric Psychiatrist with Geriatric and Adult Psychiatry, LLC, a
provider of psychiatric services to the community, nursing homes, and assisted living
facilities. Dr. Jackson is active in AMDA where she received her Medical Director
certification. She is the Medical Director for the Alzheimer's Resource Center in
Southington, CT, as well as Assistant Clinical Professor at the Yale University School of
Medicine. From 1999-2002, she chaired the Clinical Practice Committee of the American
Association of Geriatric Psychiatry. In 2004, she was awarded the Clinician-of-the-Year
Award by the American Association of Geriatric Psychiatry. Dr. Jackson speaks nationally
on issues of aging, long-term care, dementia, geriatric depression, and behavior

Jeri Jackson, BSN, MS, MSN is a Nurse Consultant with CMS and has 32 years of
experience in nursing. Ms. Jackson began her career with the Army Nurse Corp, and then
moved to the private sector, where her work experience included patient financial services,
risk management, utilization review, and performance and patient care improvement. Ms.
Jackson has worked in many areas of nursing, including surgery, the emergency department,
recovery, shock trauma, surgical intensive care, and psychiatric units. In her current role

with CMS, Ms. Jackson works with several programs, including long term care, hospitals,
complaints, ICF/MR, and psychiatric facilities.

Steven Levenson, MD, CMD, is a physician with over 25 years of experience in geriatrics
practice and medical direction in long-term care settings, including nursing homes, chronic
hospitals, and assisted living. Through the years, he has provided medical direction for many
facilities in Maryland. He has been prominent in national organizations such as the American
Medical Directors Association, dedicated to improving physician performance and care
quality in long-term care, for which he has received several national awards. Dr. Levenson
has been involved with CMS since the late 1980s in work groups developing and revising
surveyor guidelines and regulations.

Carla Saxton McSpadden, RPh, CGP is a certified geriatric pharmacist and currently
serves as Assistant Director of Policy and Advocacy with the American Society of
Consultant Pharmacists. She has worked in a variety of pharmacy settings including retail
pharmacy and long-term care dispensing, consulting, and IV services. She currently serves as
Vice-Chairperson for the National Coordinating Council for Medication Error Reporting and
Prevention, while also participating in the Pharmacy Career Information Clearinghouse,
National Council for Prescription Drug Programs‟ Long-Term Care Work Group, and the
Pharmacist Services Technical Advisory Coalition.

Todd Semla, MS, PharmD, BCPS, FCCP, is a Clinical Pharmacy Specialist for the
Department of Veterans Affairs Pharmacy Benefits Management Program. He is also an
Associate Professor in the Department of Psychiatry and Behavioral Sciences at
Northwestern University's Feinberg School of Medicine. Dr. Semla is the Section Editor for
"Drugs and Pharmacology" in the Journal of the American Geriatrics Society and is the
Society's President-elect. He has over 20 years experience in geriatric and psychiatric
pharmacotherapy. He co-authored two books, "Geriatric Dosage Handbook" and "Geriatrics
at Your Fingertips."

Matthew S. Wayne, M.D., is the Chief Medical Officer and a full-time, on-staff geriatrician
for the Eliza Jennings Senior Care Network (EJSCN). Dr. Wayne oversees the resident and
clinical care policies for all of the EJSCN communities and community-based services. Dr.
Wayne is board certified in internal medicine, is a certified Medical Director, and has a
certificate of Additional Qualifications in Geriatric Medicine. He is currently vice president
of the Ohio Medical Directors Association. In addition, Dr. Wayne serves as an Assistant
Clinical Professor of Medicine at Case Western Reserve University School of Medicine. He
also is co-author of the Multi-disciplinary Medication Management Toolkit, which is
published by the American Medical Directors Association.

                   Nursing Home Journal IV, Unnecessary Medications
                                  Satellite Broadcast
                             TECHNICAL FACT SHEET

               DATE: December 15, 2006
           TEST TIME: 12:30 – 1:00 p.m. EST
                      11:30 – 12:00 p.m. CST
                      10:30 – 11:00 a.m. MST
                      9:30 – 10:00 a.m. PST

    PROGRAM TIME: 1:00 – 2:30 p.m. EST
                  12:00 – 1:30 p.m. CST
                  11:00 – 12:30 p.m. MST
                  10:00 - 11:30 p.m. PST

NUMBER:         703-812-8816

TROUBLE                    410-786-3618

CMS Digital Network:       Channel 712

Individuals and Sites outside of the CMS satellite network who wish to set up a site for this
program or view this broadcast via webcast should go to
http:// to register. Handouts can also be found at that website.

Satellite Coordinates

                           Guidance for Locating Downlink Sites
In general, there are 2 major formats for satellite transmission - digital and analog. CMS uses
both analog and digital formats, CMS‟s Digital network is a closed network which can only
be viewed by its ten regional offices and several State survey agencies in regions VIII, IX,
and X. The Digital format that CMS uses is called Digicipher. CMS is also capable of
transmitting and receiving programs in KU-band and C-band analog. Ku-band and C-band
have been in use for many years, can be received by thousands of „steerable‟ analog dishes
nationwide. C-band is the oldest transmission signal and the most widely used. NOTE: This
is NOT „video conferencing,‟ which is carried by telephone lines.

                             Locating an Analog Downlink Site
Potential Analog Downlink Sites: There are thousands of steerable analog downlink dishes
nationwide at public schools, colleges, libraries, hotels, television stations, restaurants,
private residences, etc. A few calls should locate one near you.

   Here are some places to start calling:
    Your Local Cable and Satellite Television Provider: Contact your local cable/satellite
      television distributor, which is probably listed under “Television -- Cable &
      Satellite.” Ask to speak with the programming staff and inquire about their
      willingness to simulcast the broadcast on your area's public access channel. Advise
      them that this broadcast is free of charge. Satellite television distributors may be able
      to provide you with a list of public institutions such as libraries, community centers,
      health care centers, and public schools that subscribe to their services. You may also
      wish to contact your local public TV station and ask that they download and air the
      program on their station.
    Public Libraries: Larger public libraries are a good place to check for satellite
      downlink facilities. Check library listings in the local government section of the blue
      pages of your local telephone directory.
    Educational Institutions: Universities, community colleges, and large public high
      schools often have satellite downlink capabilities.
    Hotels and Business Centers: Large hotels that frequently host conventions in
      business districts, may be able to receive satellite broadcasts. These hotels may
      charge a fee for viewing.
    Health Care Facilities: Many hospitals and health maintenance organization (HMO)
      offices have satellite reception capabilities.
    Copy Centers: Commercial office supply centers may also have satellite capabilities.

              What Information Do I Need to Give the Site Contact Person?
When you contact an analog site, you will need to give the contact person the satellite
coordinate information. The coordinates for the broadcast should be made available from the
Central Office contact approximately 30 days prior to the broadcast.
Here is the information you will need to provide:
    Transmission Type:
    Satellite:
    Orbital Location:
    Transponder:

      Polarity:
      Downlink Frequency:
      Satellite Help Hotline:
      Broadcast Schedule:
      Test Signal:
      Broadcast Title:
                                  Reserving a Downlink Site
You will need to know what to ask the person who answers the phone, who may or may not
be the best person at that organization to help.

If the facility has an analog satellite:
You are interested in viewing a satellite C-band and/or KU band analog broadcast and you
understand that this facility may have that capability. You should have the satellite
coordinates for reference. Some satellite dishes can‟t be pointed to all satellites.

You should also ask:
    If the facility can receive the broadcast, is the viewing room open to the public and
      not reserved for another use at the time of the broadcast?
    If the viewing room is available, how many people will it hold, and is there any fee
      for its use?
    Will the facility let you phone or fax your questions in to a toll free number?
    You should point out that this broadcast is open to the public and employees of the
      hosting facility with an interest in the topic are welcome.
    As a courtesy, you should offer the hosting facility a list of the people who will
    Are there any special arrangements necessary for entry to the site?
    It is your responsibility to arrange for sign language interpretation if you anticipate
      that individuals with hearing impairments will attend.

If you find a site, you should be prepared to perform as site coordinator.
Typically, site coordinators will:
     Locate a suitable location.
     Promote the event locally.
     Direct individuals to register if necessary
     Download material (e.g., sign-in sheet, evaluation, participant guide) if available
     Ensure that participants sign in on the day of the event.
     Distribute copies of the participant guide and handouts to participants the day of the
     Assist participants with the use of the distance learning equipment.
     Receive instructions from the broadcast director regarding any activities they may be
        asked to facilitate.
     Encourage active participation in event activities.
     Record the broadcast for office use.
     Encourage participants to complete the evaluation form located at