The Global Asthma Initiative (GINA) has updated its guidelines for 2025. Some ofthe key changes include looking at additional biomarkers for Type 2 inflammation, additional risk factors for severe exacerbation in adults, including environmentalfactors and air quality that they are exposed to, and the impact of extreme weather.The diagnosis criteria have also been updated for clarity because variability insymptoms and expiratory airflow are two distinct characteristics of Asthma.Additionally, a reference to a calculator of peak expiratory flow variability was alsoadded.
Treatment recommendations for adults are in two treatment tracks for better clarity, and due to poor access to some preferred combination inhaled products. The main key difference is the medication that is used for symptom relief. Track one maintains an "as needed" inhaled corticosteroid (ICS) - formoterol combination product such as Symbicort or Dulera as the preferred treatment approach. Formoterol substantiallyreduces the risk of severe exacerbations and systemic corticosteroid exposure ascompared to short-acting beta agonists (SABA) based regimens. Also, thecombination products provide a simpler regimen and better overall compliance.
Track 2 uses the alternative approach of “as needed” SABA or as needed ICS-SABA(ie, Airsupra -combo product or albuterol and a steroid inhaler separately), which maybe a good option for patients with controlled stable asthma and no exacerbations. Itis recommended to ensure the patient is good with medication adherence beforeusing one of these suggested products.
The U.S. Department of Veterans Affairs (VA) and Department of Defense alsoreleased updated clinical practice guidelines for Asthma in March 2025. Like the GINAguidelines, the VA also makes strong recommendations for the use of ICS incombination with a long-acting beta agonist (LABA) such as formoterol as both acontroller and reliever for those with uncontrolled asthma.
Lastly, the latest studies show that the use of Proton Pump Inhibitors (PPI) has beenassociated with increased asthma incidence. While PPIs are used to manage GERD,which itself can also worsen symptoms of asthma, the use of PPIs may not be thebest option in asthma patients. If there are residents who are on PPIs and seem tocontinue having asthma that is uncontrolled, consider switching to an H2-receptorantagonist such as famotidine or ranitidine.
Asthma is a chronic condition that can affect many residents in the nursing homesetting. Proper management by identifying triggers, educating residents and staff,and having up-to-date knowledge of new and preferred treatment options can begreatly beneficial in better controlling and reducing asthma exacerbations in theelderly.
The vaccine manufacturers (Pfizer, Moderna) expect the new vaccine will be available mid to late August, while Novavax anticipates a slightly later release in September but still in time to begin the fall vaccine administrations once the final approval is received by the FDA. The current COVID-19 2023-24 vaccine is still approved for administration, likely for the remainder of the summer, however, production of the 2023-24 formulation has stopped as manufacturers gear for the new formulation.
Currently, Pfizer has stopped shipping all 2023-24 from Pfizer direct. Going forward, additional doses of Pfizer and Moderna may be obtained through regular wholesalers or vendors IF they have any more stock remaining. Once the 2023-24 is completely depleted from all Vendors, facilities should wait until the new formulation is available early fall.
Facilities are encouraged to review all patients who did not receive any vaccine or dose of the 2023-24 formula and administer it as a priority for those patients. For all others who have already received at least one dose of the 2023-24 formula in recent months, it may be beneficial to wait for the new formulation at the discretion of the healthcare provider and facility protocol.
The ACIP and CDC advisory group made official recommendations on June 27, 2024, for who should get the new vaccine in the fall. They continue to support vaccination against Covid-19 with one dose of the new 2024-25 formulation in all individuals ages 6 months and older irrespective of whether they were previously vaccinated for COVID-19.
SpecialtyRx Account Executives can also assist in some aspects of survey preparation with regards to med cart audits, medication storage, and ensuring emergency kits are intact and within expiration dates.
Latest MDS 3.0 v 1.18.11 as of October 1, 2023 – The main focus is the resident’s voice, direct resident interview and goals of individualized care plans. Below is a quick reminder of some of the changes that took place in October 2023:
Survey-related forms were changed based on the upcoming changes to the MDS. Due to Section G being removed from the MDS, fields on the CMS-672 form can no longer be completed, and these MDS-based fields are not used as part of the survey process any longer, anyway. Facilities do not have to complete fields F79-F145 and surveyors do not need to populate F79-93 in the survey system. The following should still be completed:
As of October 22, 2023, the above fields were relocated from the CMS-672 to the CMS- 671. The CMS-672 has been removed.
Upcoming Quality Measure changes to the CMS five-star rating to look for in 2024 are as follows:
The MDS (minimum data set) 3.0 RAI (resident assessment instrument) will again be updated to V1.19.1 effective October 1, 2024. The key differences to expect:
There are a lot of changes to Nursing Homes on the way – starting this summer and proceeding into the following year! SpecialtyRx will keep you informed and give reminders as changes go into effect. We know you are focused on daily patient care and SpecialtyRx is your long-term partner with the same goals and values. Together, we can prioritize the needs of our patients!
Medication administration is a critical part of patient care, and the method of administration can be just as important as the medication itself. Certain medications should never be crushed, split, or altered because doing so can change how they work and, in some cases, put both residents and healthcare staff at risk.
"Do Not Crush" medications have special formulations designed to:
For example, extended-release medications are designed to release slowly over time. Crushing these medications can cause dose dumping, releasing the entire dose at once instead of gradually. This can increase the risk of side effects or toxicity.
Some medications must reach a specific part of the digestive tract—such as the intestine—to be absorbed properly. Crushing these medications may reduce or eliminate their effectiveness, leading to poor clinical outcomes.
Additionally, certain medications, including some antineoplastics and other hazardous drugs, can pose risks to caregivers if crushed. Altering these medications may create airborne particles or residue that can be inhaled or absorbed through the skin.
To help ensure medication safety:
Medication guidance and "Do Not Crush" recommendations are updated regularly. SpecialtyRx is developing an updated Do Not Crush List (hello pharmacist link) that can be posted in medication rooms or included in medication cart binders for easy reference. More to come soon!
Ongoing staff education and routine reminders are essential to promoting safe medication practices. Crushing medications when it is not appropriate can alter their effectiveness, increase the risk of adverse events, and create safety hazards for both residents and healthcare professionals.
Consistently using the most up-to-date Do Not Crush List and partnering with your SpecialtyRx pharmacy team are key steps in ensuring safe, effective, and compliant medication administration.
Gabapentin is commonly used in long-term care and skilled nursing settings. Because it is available under multiple product names, strengths, and dosage forms, it's important to verify the exact formulation being prescribed and dispensed—especially during admissions, readmissions, and resident transfers.
A recurring medication selection error occurs when Gabarone (gabapentin) tablets are selected instead of Neurontin (gabapentin) capsules. This can happen during order entry, medication reconciliation, or e-prescribing when the active ingredient and strength appear similar.
Facilities should pay particular attention to 100 mg and 400 mg orders. These strengths are available as Gabarone (gabapentin) tablets (High-Cost Brand) and are also commonly prescribed as gabapentin capsules, increasing the risk of selecting the incorrect dosage form.
Selecting tablets when capsules were intended can result in:
A quick verification of the intended dosage form can help prevent unnecessary costs, insurance claim rejections, and delays in resident care. Whenever reviewing a gabapentin order, confirm whether the prescribed product is a capsule, tablet, or oral solution before dispensing or administering the medication.
Tardive dyskinesia (TD) can be easy to overlook in nursing facility residents. Although second-generation antipsychotics (SGAs) are often perceived as carrying a lower risk, residents can still develop persistent involuntary movements, particularly with long-term use, advanced age, and polypharmacy.
One ongoing concern is the inappropriate use of benztropine. Recent prescribing patterns suggest that benztropine may still be prescribed prophylactically alongside antipsychotics or added in response to suspected TD. However, benztropine is **not indicated for the treatment of TD and may actually worsen symptoms.**
Benztropine may be appropriate for the treatment of drug-induced Parkinsonism or acute dystonia—conditions that can sometimes be mistaken for TD. Because these movement disorders require different treatment approaches, accurate identification is essential before initiating or continuing anticholinergic therapy.
For residents with confirmed or strongly suspected TD, treatment should focus on therapies specifically approved for the condition. VMAT2 inhibitors, including Ingrezza® (valbenazine) and Austedo® (deutetrabenazine), offer a more appropriate treatment approach than anticholinergic medications.
Improving the recognition and management of TD presents an important opportunity to enhance resident care. Early identification can lead to more timely interventions, improved comfort, and better clinical outcomes.
From a facility perspective, supporting evidence-based treatment decisions can also help align care with current best practices and quality-focused initiatives. Appropriate management of TD benefits both resident-centered outcomes and overall facility performance.
Small actions can make a meaningful difference in identifying TD and supporting timely treatment.
By recognizing TD early and advocating for evidence-based treatment, nursing teams can help improve resident comfort, dignity, safety, and quality of life.
Stay ahead – and in the know – in our rapidly evolving industry.
You’re invited to step aboard for a tropical seminar like no other!
Join SpecialtyRx for another show-stopping seminar at sea, filled with learning, networking, and entertainment.
Step aboard for a tropical seminar like no other where learning meets luxury and paradise meets purpose.
Educational sessions will be presented by CoreTactics.
Registration: 9:30 AM
Boat Departure: 10:00 AM
Sail Time: 10:00 AM–3:00 PM
4 CEUs will be provided to Administrators.
Kosher food and complimentary parking will be provided.
SpecialtyRx Celebrates Ribbon-Cutting of Expanded Orlando Pharmacy
SpecialtyRx proudly marked a significant milestone with a ribbon-cutting ceremony celebratingthe expansion of its Orlando location, now the state's largest single-site pharmacy. The eventbrought together leadership, team members, and partners to commemorate the organization'sgrowth and its continued commitment to excellence in pharmacy services.The expanded facility enhances the company’s ability to better serve patients and partners whilecontinuing to invest in advanced technology, operational excellence, and its growing team.SpecialtyRx looks forward to building on this momentum as it continues to grow and servecommunities across Florida and beyond.
