"as-needed", opioids, range, safety, titration



  1. McPherson, Mary Lynn PharmD, BCPS
  2. Kaiser, Karen S. PhD, RN, AOCN
  3. Burns, Cameron PharmD


For safety reasons, the 2004-2005 Joint Commission on Accreditation of Healthcare Organizations standards require organizations to develop policy addressing various types of medication orders that have the potential for being ambiguous to those dispensing or administering medications. This includes range, titration, and as needed orders for analgesics and other medications used in palliative care. One sample policy that addresses prescribing and interpretation of these types of orders is presented, as well as case examples illustrating this process. These types of orders should contain an indication, a minimum dosing frequency, the dose range if appropriate (not to exceed a doubling for patient/family medication administration), titration instructions, and clinical parameters to guide dose administration. Hospice and palliative care organizations should develop their own policy for accepting orders of this nature to enhance patient safety.