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Ask the Expert: Three tips to comply with MM standards

Accreditation Connection, July 4, 2005

With three medication management standards topping the charts of the most commonly cited standards in 2004, according to the April 2005 edition of Joint Commission Perspectives, how are you supposed to comply?

Michael Hoying, RPh, MS, pharmacy director for Fairview and Lutheran hospitals in Cleveland, offers three tips to help you comply with the troublesome medication management standards.

1. Oral orders

There's more to verbal order standards than just the read-back. First, oral orders can only be given in emergencies; for nonurgent care, written orders are required.

Second, only nurses (within the scope of your state laws), respiratory therapists, nurse practitioners, and physician assistants may take oral orders. Third, questions need to be brought up immediately with the physician.

When taking orders, the following information is mandatory: Patient and drug names, dosage form, dosage route, duration, name of prescriber, name of the person recording the order, and for as-needed meds, indications for use.

2. Labeling and dispensation

Two standards will hit close to home: one requires that the hospital safely dispenses medications to patients; the other dictates that medications be labeled appropriately. Although you're probably current with new hospitalwide policies that provide for compliance with these two standards, check with staff to confirm the following:

 Do they understand the hospital's standardized labeling system for medications?
 Do they understand that all medications must be labeled with drug name, strength, amount when not apparent from the container, and the expiration date?
 Do they feel that meds are dispensed in the most ready-to-administer forms available?

3. Handling emergency meds

Emergency medications have their own standards. On the floor of your department, how are emergency meds handled? New standards require them to be "consistently available, controlled, and secure in patient care areas." Pharmacy and clinical staff should decide the final handling of this important standard, but they can consult with committees and other leadership.

To prove to the JCAHO that crash-cart medication integrity has been maintained, nursing staff need to validate it daily. Hospital leadership must set up a system to ensure meds are replaced by the pharmacy as soon as possible after they are used.

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