The New Section N: Use and Indication of High-risk Drug Classes

We will see changes in Section N of the MDS 3.0 effective on October 1, 2023.  Section N0410 (Medications Received) has been eliminated and is being replaced with Section N0415 (High Risk Drug Classes: Use and Indication).

The updated version expands the medication list to include antiplatelets and hypoglycemics including insulin. Also, the new section adds a column titled “indication noted.”

What is Section N Asking?

Per the draft instructions, the MDS Coordinator will check the appropriate box

if the resident is taking any medications by pharmacological classification, not how the medication is used, during the last 7 days or since admission/entry or re-entry if less than 7 days.

If column 1 is checked, check if there is an indication noted for all medications in the drug class.

Disclaimer. This information is current as of November 23, 2022


About This Series

October 1, 2023 will bring a new MDS for us all to manage.  While there's still many details to finalize, the MDS Consultants team has gone through the known changes in Item Set version 1.18.11 to share with you these section-by-section primers.

Read the whole series to get prepared!

The added item set will require clinicians to verify if the resident is taking the high-risk medications and determine whether an indication of use is documented for all medications received in the drug classes.


  • ASA
  • Pletal/Cilostrazol
  • Plavix/Clopidogrel
  • Aggrenox
  • Brillinta/Ticagrelor
  • Persantine/Dipyridamole
  • Ticlid/Ticagrelor


  • Insulin
  • Metformin/Glucophage
  • Amaryl/Glimepiride
  • Prandin/Repaglinade
  • Actos/Pioglitazone
  • Januvia/Sitaglptin
  • Jardiance/Empagliflozin
  • Trulicity/Dulglutide
  • Victoza/Liraglutadine
  • Glucotrol/Glipizide

Examples of Antiplatelet and Hypoglycemic medications. (Not an all-inclusive list)

What is Changing? What does the addition of Use and Indication mean?

These high-risk drug classes, identified by CMS, will require staff education to recognize side effects that could adversely impact the resident’s health, quality of life, and safety.

The interdisciplinary team (IDT) led by a nurse, medical director, and pharmacist will need to identify high-risk medications used in the facility. The team will need to ensure staff, residents and resident representatives, understand indications for use, and monitor for adverse effects.

Recommendations from MDS Consultants

The MDS Coordinator will need to work in collaboration with facility leadership and the IDT to establish a process of review and monitor high risk medication. This process should be tracked and monitored as part of the facility’s QAPI program.

A review of documentation to ensure there is an indication when a high-risk medication is in use and monitoring for efficacy and adverse effects is completed should be completed now. If a gap is noted, a plan for improvement will need to be put in place and monitored.

Do not wait! The time to prepare is now.

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