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JCAHO revises medication labeling expectations

Pharmacy Regulation Resource, January 18, 2006

Staff preparing medications in the perioperative and other procedural settings will no longer have to initial and date the medication label, according to changes the JCAHO announced January 11.

The commission revised the implementation expectations for National Patient Safety Goal 3D, which requires organizations to label medications and containers on and off the sterile field in perioperative and other settings, to make them more consistent with the medication management chapter requirements, according to the December 2005/January 2006 This Month at the Joint Commission e-newsletter.

Neither the initialing nor the dating expectations are required under standard MM.4.30, which governs medication labeling.

new implementation expectations for the goal are as follows:

  • Labels include the drug name, strength, amount (if not evident from the container), expiration date if not used within 24 hours, and expiration time if it occurs in less than 24 hours
  • Two qualified individuals must verify labels visually and verbally when the person preparing the medication is not the same one administering the medication

Staff should label all medications and containers, even if only one medication is being used in the procedure, according to the JCAHO. Staff should label one medication at a time to eliminate confusion.

Medication containers include syringes, medicine cups, and basins, according to the JCAHO.

If the same staff member draws up the medication and administers it immediately, no label is required, according to a JCAHO frequently asked question posted in August 2005.