Accreditation

Policy not the only answer to range order problems

Briefings on The Joint Commission, December 1, 2005

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Teach staff about the importance of proper documentation

Learning objectives: After reading this article, you will be able to

1. list guidelines for writing range orders

2. discuss what to document when writing a range order

3. identify ways to educate staff about range-order policies

Get all staff on the same page when it comes to range orders and make sure they know how to properly document how and when they administered an order. This will help staff consistently answer surveyors' questions about the hospital's policy.

JCAHO standard MM.3.20 requires hospitals to specify in a policy the necessary elements of range orders, in which the dose or dosing interval varies over a prescribed range depending on the patient's condition.

But simply having a policy may not solve a hospital's woes completely.

"The problem with a policy is you have 600-1,000 nurses, and [the policies] stay in a book," says Michael Hoying, RPh, MS, pharmacy director at Fairview and Lutheran hospitals in Cleveland. "It's difficult for all nurses to memorize all policies."

Among 300 hospitals surveyed through September, 15% received requirements for improvement on MM.3.20, making it the fifth most-cited standard, according to JCAHO data.

Set a range

The American Pain Society outlines several guidelines for writing range orders. The guidelines include using a dosage range with a fixed time interval and a dose for which the maximum is no more than four times larger than the minimum.

For example, if a hospital followed the guidelines, 10 mg.-40 mg. would be acceptable, but 50 mg. would not, says Doug Wong, PharmD, a consultant with Pharmacy Healthcare Solutions in Fort Washington, PA.

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Briefings on The Joint Commission.

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