Mega Rule and Antibiotic Stewardship for Pharmacies


Phase 2 of the Reform of Requirements for LTC Facilities outlines requirements that facilities must meet in order to participate in the Medicare and Medicaid programs as of November 28, 2017. These requirements are aimed at improving the quality of health care and patient safety. Here are the three areas you need to be working towards as a pharmacy servicing Medicare/Medicaid facilities.


Drug Regimen Review

In a few short weeks, facilities will need to ensure a pharmacist review a resident’s medical chart during each monthly drug regimen review. In this review the pharmacist is to validate that the resident’s drug regimen is free of unnecessary drugs.


Psychotropic Drug Requirements

“Antipsychotic” drugs are now referred to as “psychotropic” drugs, which are defined as any drug that affects brain activities associated with mental processes and behavior. The new requirements include several provisions intended to reduce or eliminate the need for these. The most important is that PRN orders for psychotropic drugs are limited to 14 day supply.


Limit Mega Rule PRN orders to 14 days via FrameworkLTC

FrameworkLTC has a “Mega Rule Regulations” option targeting drugs that fall under the Mega Rule regulations. When “Use Mega Rule regulations” are on in FrameworkLTC,

  • Active PRN reorders with a days supply greater than 14 will be discontinued (only for relevant drugs)
  • Orders in open batches will be flagged for review (for relevant drugs)
  • New orders and reorders for PRN orders will not be saved if days supply is greater than 14 (for relevant drugs)



Infection Control Program

Facilities are tasked with establishing an Antibiotic Stewardship program, which includes antibiotic use protocols and a system for monitoring use, and will be discussing their efforts in this area as of November 28.

The CDC has developed Core Elements of Antibiotic Stewardship for Nursing Homes to serve as a guide for progressively implementing an Infection Prevention and Control and Antibiotic Stewardship program in a skilled nursing facility, which highlights pharmacy involvement in these ways:


Drug Regimen Review

A target of the DRR is to reduce the rates of oversight in managing antibiotic prescriptions in facilities. Training courses in infectious diseases or antibiotic stewardship can be completed online or in person for pharmacists looking to gain more knowledge in this area.*


Monitor Antibiotics via FrameworkLTC

FrameworkLTC has functionality to assist with monitoring antibiotics at the nursing station level. When the system option is turned on, FrameworkLTC will provide a list of antibiotic orders at the nursing station level that are missing a cutoff date or diagnosis. The software will also prohibit the saving of an antibiotic order (whether it be new or reorder) without a cutoff date or diagnosis.


Reporting on Antibiotic Usage by Facility

Use your vast repository of medication data within FrameworkLTC to run reports that can be shared with your facilities reflecting the levels of antibiotics used over given time periods, and can help tell the story of progress as they work to lower that number as clinically appropriate.

As a business partner, there are ways to help the facilities you service continue to offer exceptional patient care. Call SoftWriters’ Support for more information on setting Mega Rule Regulations and using the antibiotic stewardship functionality within FrameworkLTC.


*Additional materials:

CDC’s The Core Elements of Antibiotic Stewardship for Nursing Homes

Antimicrobial Stewardship in LTPAC

Antimicrobial Stewardship Program

Medication management: Five things to do better