• E-mail
• Print
• RSS

Four tips for complying with medication standards

Ambulatory Safety Monitor, April 1, 2004

Want to receive articles like this one in your inbox? Subscribe to Ambulatory Safety Monitor!

The JCAHO requires you to write and document your orders clearly-and requires other staff, such as pharmacy or nursing, to contact you at any hour if they can't read your writing, rather than interpreting it themselves.

Consider the following four tips when evaluating your compliance with the JCAHO's medication management standards.

1. Clean up messy handwriting

* Take a few extra seconds to write legibly. Print if necessary, or consider having your prescriptions electronically generated.

* Ask someone to read a sample of your prescriptions and ask them for feedback on your legibility.

* Ask your hospital to consider implementing a computerized physician order entry system.

2. Don't use 'as needed'

Medication orders or prescriptions that are written "as needed," or PRN, without a specific frequency, have often led to errors involving inappropriate doses. To avoid these errors, note the drug's indication-for-use in order to document why you are prescribing that particular drug.

You don't have to write an indication for PRN medications that only have one understood use, such as a stool softener, but you do have to write an indication if the PRN drug can have more than one use, such as Benadryl®. Your organization's policies should clarify when an indication-for-use is required.

TIP: Always indicate a frequency (e.g., Q4H PRN) and dose range (e.g., 20-40 mg) on PRN orders. Also include the reason for the drug and dose (i.e., PRN pain, PRN, fever).

3. Verbal orders and critical lab values

The JCAHO has made improving communication Goal #2 of its 2004 National Patient Safety Goals. As a result, you must reduce your reliance on oral and telephone orders. The bottom line: No verbal orders unless it's an emergency.

Never leave verbal orders on a nurse's or pharmacist's voice mail. This violates the JCAHO's National Patient Safety Goals. Besides, most state laws require nurses and pharmacists to obtain the order directly from you or your agent. Otherwise, they must call you directly to get the order and a confirmation read-back.

4. Confirm verbal orders and critical lab values

Expect your next JCAHO surveyor to closely examine your compliance with this National Patient Safety Goals requirement. Staff must read back all verbal or telephone orders-not just those for medications-to you to ensure that they are correct.

Likewise, you must obtain read-back verification of critical lab values that you receive verbally or by telephone.

The JCAHO stresses the difference between repeating back and reading back an order, so don't confuse the two. Simply repeating an order or critical lab value will not suffice. The JCAHO wants the person who received the information to write down the complete order or lab value, read it back, and then receive confirmation that it's accurate.

Want to receive articles like this one in your inbox? Subscribe to Ambulatory Safety Monitor!

• E-mail to a Colleague
• Print
• RSS
• Archive