As a new consulting pharmacist to a 60-bed, skilled nursing facility, several multiple-drug use...

As a new consulting pharmacist to a 60-bed, skilled nursing facility, several multiple-drug use problems become apparent during initial chart reviews. A typical case is D.M., an 82-year-old man who has resided there for the past month. D.M.’s past medical history is significant for hypertension, depression, constipation, long-standing mild cognitive impairment that is now worsening, and dizziness. In the nurses’ notes, it is documented that D.M. had a fall when getting out of bed last week. At admission, D.M.’s weight was 165 pounds; BP, 100/60 mm Hg; pulse, 85 beats/minute; and temperature, 98.6?F. Subsequent vital signs are not recorded systematically into his medical record. Sporadic documentation in the nurses’ notes indicates little change from admission values. No laboratory information is available at this time. D.M. has no known allergies. Current medications include amlodipine 10 mg daily, diltiazem CD 240 mg daily, hydrochlorothiazide 25 mg daily, quetiapine 300 mg daily, lorazepam 0.5 mg every 8 hours as needed for anxiety, docusate sodium 100 mg twice daily, milk of magnesia 30 mL daily, temazepam 15 mg at bedtime, and acetaminophen one to two 325-mg tablets every 4 to 6 hours as needed for pain. D.M. follows a 2-g sodium diet. D.M. is ambulatory and takes his meals in the facility’s cafeteria. He is not in any acute distress, but the nurses’ notes indicate that D.M. is often confused and complains of dizziness when ambulating. His weight has decreased 4 pounds since being admitted. What should be expected of this LTCF with respect to medication monitoring?