Accreditation

Ask the Expert

Accreditation Connection, January 6, 2005

Q: What should we know about reviewing medication orders for ED boarders?

A: Pharmacists should review medication orders for patients temporarily boarded in the emergency department (ED) or other units to comply with JCAHO medication standards, according to Michael R. Hoying, RPh, MS, Director of Pharmacy at Fairview and Lutheran Hospitals in Cleveland, OH. He is the author of The Compliance Guide to the JCAHO's Medication Management Standards: Second Edition, which goes on sale February 1, 2005.

Boarded patients are those admitted to the hospital but placed in beds in the ED or other units, such as post-anesthesia care, until an inpatient bed becomes available. Although the requirement for a pharmacist's review of medication orders does not apply for most ED patients, they do apply to those admitted to the hospital but housed in ED beds.

The ED is a physician-controlled environment and most medications are taken from floor stock, so the JCAHO does not require a pharmacist's prior review of medication orders. But admitted patients housed in the ED during a prolonged wait for an inpatient bed are technically inpatients, so medication standard 4.10 requires a pharmacist's review of medications before staff give them out. ED staff must make sure they follow the same rules as an inpatient unit once they begin the care for admitted patients.

Tip: Have the ED staff or pharmacy generate an inpatient medication administration record once the patient becomes a boarder-inpatients are considered boarders if they remain in the ED longer than two hours after admission-or the admitting physician makes a significant change in the medications regimen.

To get a copy of Hoying's new book, which is stocked with more than 45 field-tested policies, procedures, and forms, call 800/650-6787, and mention source code CGJM2, or visit our HCPro Healthcare Marketplace, and order your copy online www.hcmarketplace.com.

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