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  • 14 Questions about VA Disability Compensation Benefits Claims

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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Most Common VA Disabilities Claimed for Compensation:   

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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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20. TABLET SPLITTING

a. VISNs are permitted to establish tablet splitting programs for both inpatients and

outpatients; however, tablets are to be split for inpatients only when the required dosage is not

available in a commercial package.

b. Determination of patient suitability for a tablet splitting program must be individualized

according to a patient's unique capabilities. Patients who express a desire not to participate in a

tablet splitting program must be permitted to receive full tablets.

c. All patients in a tablet splitting program must be provided a tablet splitter and must be

educated regarding its use.

d. Tablets are not to be split into more than two pieces, unless specifically designed for that

purpose.

e. To ensure appropriateness, all medical center tablet splitting programs must be approved

by the VISN’s Formulary Committee.

f. Tablets may be split outside of a formal tablet splitting program to achieve an intermediate

dose not available with marketed strengths, or at the request of an individual provider.

g. The following requirements must be followed whenever tablet splitting is instituted.

(1) Tablets that must not be split are:

(a) Sustained release preparations (unless scored and designed to allow tablet splitting);

(b) Enteric coated tablets;

18

February 26, 2009 VHA HANDBOOK 1108.08

© Products that crumble easily;

(d) Products that cannot be split consistently into equal parts unless small fluctuations in the

delivered dose do not alter clinical effect (i.e., some HMG-CoA RIs);

(e) Products with a narrow therapeutic index, unless required for therapeutic reasons, or

titration, or where the required dose is not commercially available;

(f) Products in which tablet splitting would result in the destruction of the release

mechanism of the individual drug; and

(g) Products that are not either scored or round in shape.

(2) Any patient who is otherwise able, but is unwilling to participate in a tablet splitting

program, must be provided whole tablets if they are commercially available. Patients with

caregivers with similar reservations also need to be provided whole tablets.

(3) The patient or caregiver needs to be able to demonstrate:

(a) An understanding of the purpose for splitting medication;

(b) An understanding of the intended dose and treatment regimen; and

© The physical ability (e.g., coordination, adequate vision, etc.) to easily and accurately

split the tablet.

(4) Medications eligible for tablet-splitting must have an associated message tagged in the

master drug file that alerts the provider that the dose is being provided as a split tablet, unless

otherwise ordered. This message must appear on the screen in the Computerized Patient Record

System (CPRS) when one of the tagged medications is selected for prescription.

(5) Tablet splitting is to be considered only when it is clinically appropriate and after

determination of patient suitability and willingness to participate.

(6) If the patient is not willing or is unable to split tablets utilizing the intended device, the

provider must notify the pharmacy of the need to dispense whole tablets.

(7) Patients must be provided tablet splitting devices, free of charge, as often as necessary.

Written instructions on its use must be provided with each splitter.

(8) Directions on the prescription label must reflect the exact product and dosing

instructions. To avoid misunderstanding, providers need to prescribe the medication strength

and dose in milligrams(mg) (e.g., simvastatin 40 mg. tablet. Take 20mg [one-half tablet] daily).

One-half is to be spelled out on the label to avoid misreading “1/2” as 1-2 tablets.

19

VHA HANDBOOK 1108.08 February 26, 2009

(9) When the dose of a drug that is currently being split is changed, the new dose must be

clearly explained in writing to the patient by pharmacy. NOTE: This is to ensure the patient

does not continue to split a tablet if it is no longer warranted.

(10) The dosage strength of the whole tablet is to be printed on the label as part of the

product name.

h. If tablets are to be split for inpatients, the pharmacy must split the tablet to be dispensed in

the most ready to administer dose for the nurse, doctor, pharmacist, or other health care team

member approved to administer the medication.

i. Split tablets for inpatient use must be bar coded in order to be recognized as the

appropriate final dose in the Barcode Medication Administration (BCMA) system.

SOURCE: http://www1.va.gov/vhapublications/ViewPub...asp?pub_ID=1834

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I am not willing to split tablets.

Thanks for this post

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Timely post, just finished conversation with husband few minutes ago on the same subject. Tiny pills are hard to split. Will post how it works out.

Cg'up2009!

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allan,

Great post !

I'm crazy - I usually bite mine in half or 5/8's - lol.

carlie

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Mee too. I wonder if we crack a tooth splitting a SC medicine can we file a secondary claim?

J

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