1. Adamski, Patricia RN, MS, MBA


The Joint Commission promotes safe and effective medication management through continuous compliance with its medication management sandards.


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The Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) medication management standards exist to encourage organizations to establish safe, effective, and comprehensive medication management systems.


Q MM.2.10, element of performance 4, requires that mechanisms and processes are established to monitor patient responses to a newly added medication before the medication is made available for dispensing or administration in the organization. How can an organization do this?


A The organization should ensure that it's capable of monitoring patient response to a medication before procuring it. Among questions organizations might ask to determine their capability is whether any laboratory tests are required to monitor the effects of the medication. Such tests might include sensitivity to a new antibiotic or lab values to monitor specific known side effects of the drug. Other questions to ask include, does the organization have the ability to perform these laboratory tests? Do staff members with responsibility for monitoring the effects of medications have the appropriate knowledge, resources, and competency to do so?


Q Must the indication, diagnosis, or condition be a component of a medication order?


A No. The organization must be able to show a documented diagnosis, condition, or indication somewhere in the clinical record for each prescribed drug. This diagnosis, condition, or indication may be in the order, a progress note, the history or physical, or elsewhere in the clinical record.


Q How should organizations specify the required elements for range orders?


A The purpose of specifying these required elements is to ensure that medication orders are written clearly. A clear order allows for a clear and common understanding-among the prescriber, the pharmacist, and the person administering the dose-about how the medication will be administered. The prescriber must know exactly how the medication will be administered. The order must be interpreted consistently by all individuals involved in the medication process. If the individual administering the dose chooses a dose or frequency, then the basis for any such decision must be agreed upon and clearly understood before the medication is administered. There are a number of approaches an organization may take to specify the required elements of range orders. Some examples are:


[white diamond suit] Organizations may choose to limit potential variability in how the dose is administered by requiring that the order may contain a range for dosage or a range for frequency, but may not include ranges for both in the same order.


[white diamond suit] Organizations may choose to limit potential variability in how the dose is administered by requiring that the order must specify the dose, frequency, and route of administration, along with specific indications for the use of each dose.


[white diamond suit] Organizations may develop detailed protocols or guidelines which specify-based on a pain scale or other measurable parameter-the dose with which to begin, the circumstances and time frames under which dosing is to be adjusted based on pain reassessment, and the prescribed increments of such adjustments.