Measure 238 – Use of High-Risk Medications in the Elderly

Audit Criteria

When we’re reviewing your clinicians’ data, it may be helpful to know what we are looking for in order for us to verify to CMS that your data is accurate and complete. Measure 238 requires documentation of 1). the percentage of patients who were prescribed at least one high-risk medication during the measurement period by the eligible clinician, and 2). the percentage of patients with at least two orders for the same high-risk medication during the performance period with at least one of the prescriptions coming from the eligible clinician.

 

This documentation may be found in the patient’s medical record. The relevant document should be made available to the auditor for the patient requested.

 

NOTE: This is an inverse measure. Report the performance met code (G9365) when one high-risk medication is ordered, and the performance met code (G9367) when at least two orders for the same high-risk medication are ordered. The performance not met codes (G9366 and/or G9368) indicate better quality care.

 

What medications are included in the measure submission?

Your auditor will be looking for the following medications to verify that the numerators were appropriately reported:

Table 1: High-Risk Medications at Any Dose or Duration

Description

Prescription

Anticholinergics, first-generation antihistamines

Brompheniramine

Carbinoxamine

Chlorpheniramine

Clemastine

Cyproheptadine

Dexbrompheniramine

Dexchlorpheniramine

Dimenhydrinate

Diphenhydramine (oral)

Doxylamine

Hydroxyzine

Mecilzine

Promethazine

Tripolidine

Anticholinergics, anti-Parkinson agents

Benztropine (oral)

Trihexyphenidyl

Antispasmodics

Atropine (exclude ophthalmic)

Belladonna alkaloids

Clidinium-chloradiazepoxide

Dicyclomide

Hyoscyamine

Propantheline

Scopolamine

Antithrombotics

Dipyridamole, oral short-acting (does not apply to the combination with aspirin)

Ticlopidine

Cardiovascular, alpha agonists, central

Methyldopa

Guanfacine

Cardiovascular, other

Disopyramide

Nifedipine, immediate release

Central nervous system, antidepressants

Amitriptyline

Amoxapine

Clomipramine

Desipramine

Imipramine

Nortriptyline

Paroxetine

Protriptyline

Trimipramine

Central nervous system, barbiturates

Amobarbital

Butabarbital

Butalbita

Pentobarbital

Phenobarbital

Secobarbital

Central nervous system, vasodilators

Ergot mesylates

Isoxsuprine

Central nervous system, other

Meprobamate

Endocrine system, estrogens with or without progestins; include only oral and topical patch products

Conjugated estrogen

Estropipate

Estradiol

Esterified estrogen

Endocrine system, sulfonylureas, long- duration

Chlorpropamide

Glyburide

Endocrine system, other

Desiccated thyroid

Megestrol

Pain medications, skeletal muscle relaxants

Carisoprodol

Chlorzoxazone

Cyclobenzaprine

Metaxalone

Methocarbamol

Orphenadrine

Pain medications, other

Indomethacin

Meperidine

Ketorolac, includes parenteral

Pentazocine

 

Table 2: High-Risk Medications with Days Supply Criteria (these medications are not considered high-risk for purposes of this measure unless they meet the days supply criteria)

Description

Prescription

Days Supply Criteria

Anti-Infectives, Other

Nitrofurantoin

Nitrofurantoin macrocrystals

Nitrofurantoin macrocrystals-monohydrate

>90 days

Nonbenzodiazepine hypnotics

Eszopiclone

Zolpidem

Zaleplon

>90 days

 

Table 3: High-Risk Medications with Average Daily Dose Criteria (these medications are not considered high-risk for purposes of this measure unless they meet the average daily dose criteria)

Description

Prescription

Average Daily Dose Criteria

Alpha Agonists, Central

Resperine

>0.1 mg/day

Cardiovascular, Other

Digoxin

>0.125 mg/day

Tertiary TCAs (as single agent or as part of combination products)

Doxepin

>6 mg/day