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New JCAHO Standards to Reduce Medication Errors 

In 2004 the Joint Commission introduced new regulations to reduce medication errors. These new regulations went into effect in January 2004 with many more to follow. A part of these new regulations include the Medication Management standard .3.20. The rationale behind the standard states that many medication errors occur while communicating or transcribing medication orders and that the hospital should take steps to reduce the potential for error or misinterpretation when orders are written or verbally communicated. Elements of performance of this standard require written policies addressing:

  1. The required elements of a complete medication order
  2. When generic or brand names are acceptable or required as part of a medication order
  3. Whether or when indication for use is required on a medication order
  4. Any special precautions or procedures for ordering drugs with look-alike or sound-alike names
  5. Actions to take when medication orders are incomplete, illegible, or unclear
    • The hospital specifies the required elements of any of the following types of orders that it deems acceptable for use:
    • "As needed" (PRN) orders
    • Standing orders
    • Hold orders
    • Automatic stop orders
    • Resume orders
      •  Note: -A blanket reinstatement of previous orders for medications is not acceptable.  
    • Titrating orders--orders in which the dose is either progressively increased or decreased in response to the patient's status
    • Taper orders--orders in which the dose is decreased by a particular amount with each dosing interval
    • Range orders--orders in which the dose or dosing interval varies over a prescribed range, depending on the situation or patient's status
    • Orders for compounded drugs or drug mixtures not commercially available
    • Orders for medication-related devices (for example, nebulizers and catheters)
    • Orders for investigational medications
    • Orders for herbal products
    • Orders for medications at discharge
  6. Minimizes the use of verbal and telephone orders
  7. Reviews and updates preprinted order sheets as needed
  8. Specifies that blanket reinstatement of previous orders for medications are not acceptable
  9. Defines in writing when weight-based dosing for pediatric populations is required

One of the many difficult standards to enact is the blanket reinstatement of previous orders. This includes terminology such as Resume Orders, Continue Orders, Continue Home Medications and similar terminology. If JCAHO surveyors find these types of orders written, they will report the hospital out of compliance with this standard. In the past when a facility was out of compliance with any standard, JCAHO would just give a score and move on. As of January 1, 2004 when JCAHO issues an out of compliance recommendation, the facility is required to correct the problem and prove it is compliant.  Failure to comply could result in loss of payments from Medicare and third party payers.


To assist in compliance with this standard, NAMC nursing staff can print a current list of medications to assist the physician in the review of current patient profile.


Please remember this is a national policy that all JCAHO accredited organizations must follow. NAMC Administration and Directors are required to enforce this regulation or loose valuable funding. 

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