Medication Management

People living in a nursing facility (NF) are often prescribed multiple medications to achieve specific outcomes, such as reducing or eliminating symptoms of a medical condition.

All medications have the potential for adverse side effects, but some medications pose higher risks for older adults than others. Prescribers must consider both the risks and potential benefits of a medication, and NFs must have systems in place to monitor for adverse side effects.

Policies and procedures provide the framework for the NF’s system for medication management. Policies and procedures should be specific to the NF and address the needs of its population. Other factors include:

  • Acquiring, receiving, dispensing and administering medications.
  • Appropriate labeling, storage and disposal of medications, including controlled substances.
  • Personnel authorized to access or administer medications, as well as staff training and competency evaluations.
  • Medication regimen review, deprescribing and medication regimen simplification.
  • Appropriate use of psychoactive medications and gradual dose reduction.
  • Monitoring for adverse events including any recommended laboratory tests.
  • Medical record documentation.

NFs must have an effective, comprehensive, systematic and continuous Quality Assurance Performance Improvement (QAPI) program, using data to drive quality improvement. Situations related to medication management that could lead to intervention by the QAPI program include:

  • Inappropriate use of specific medication classes, such as psychoactive medications or antibiotics.
  • Adverse medication effects.
  • Medication errors.

The toolkit below includes evidence-based resources that will assist NF staff in developing effective systems for safely managing medication use.

Resources from HHSC

Evidence-Based Best Practices for Medication Management in Long-Term Care (PDF) provides an overview of best practice recommendations for medication management in NFs.

Tips for Glucometer Use and Care (PDF) provides NF staff with step-by-step recommendations for the proper use of glucometers, including quality control, calibration and disinfection between uses.

Medication Management: Diabetes Mellitus (PDF) addresses the differences between Type 1 and Type 2 diabetes, medications used to manage diabetes, and the recommendations against using sliding scale insulin as a primary means for controlling blood glucose levels.

Resources from Other Organizations

Agency for Healthcare Research and Quality

Deprescribing as a Patient Safety Strategy provides information on safe deprescribing strategies.

Suspected UTI SBAR Toolkit: Suspected UTI SBAR Form can be used by NF staff to help distinguish between a urinary tract infection (UTI) that requires treatment with antibiotics and asymptomatic bacteriuria.

American Geriatrics Society

Updated Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults provides access to the 2023 revision to the Beers Criteria® and related resources. (Note: Access to these resources requires registration at the AGS website.)

AGS Pocket Guide to the 2023 AGS Beers Criteria®(PDF) provides an overview of the most recent version of the Beers Criteria®. It is designed to assist clinicians with the safe prescribing of medications for older adults.

Centers for Medicare and Medicaid Services

Adverse Event Trigger Tool (PDF) was developed for use by surveyors but can be used to help NFs identify situations that may indicate an adverse drug event has occurred.

Guidance for Performing Root Cause Analysis (RCA) with Performance Improvement Projects (PIP) [PDF] is an overview for using RCA to evaluate adverse events and then develop corrective plans and part of their PIP.

Long-Term Care Survey Pathways are used by surveyors to evaluate specific areas of care including medication administration, unnecessary medications and medication storage. These pathways can also be used by NFs to evaluate their systems as well. (Note: Scroll down the page to Downloads and choose Survey Resources, then choose a pathway from the ZIP file.)


Resources for Patients and Healthcare Providers provides information that can be used when considering deprescribing, including deprescribing algorithms, educational pamphlets and decision aids.

Lown Institute

Deprescribing for Patient Safety is a resource for issue briefs, webinars and other resources related to deprescribing.

The Society for Post-Acute and Long-Term Care Medicine (American Medical Directors Association)

Choosing Wisely: Fifteen Things Physicians and Patients Should Question in Post-Acute and Long-Term Care identifies potentially unnecessary diagnostics tests, treatments and medications in older adults.

Drive to Deprescribe is an ongoing initiative to reduce polypharmacy and inappropriate medication use in the long-term care setting. This website has resources that can assist prescribers and NF staff in ensuring they are optimizing medication use in their facilities.