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Change in requirement for ED pharmacy review
Surveyors to accept a broader view of MM 4.10
Just 14 weeks after The Joint Commission approved an interim action that allowed pharmacists to retrospectively review ED medication orders to comply with element of performance (EP) 1 for standard 4.10 of medication management, the action was suspended.
According to Robert A. Wise, MD, vice president of The Joint Commission's Division of Standards and Survey Methods, the interim standard was put into effect because allowing retrospective review appeared to be a good solution. But the Joint Commission got a mixed reaction from the field — some thought it was helpful and others said it made things worse.
Emergency departments reported that they didn't have enough pharmacists to perform retrospective reviews of all medication orders written in the ED. Instead of looking for a "quick fix" to solve the problem, The Joint Commission instead is developing revisions to the standard, and will conduct a field review before finalizing those changes, says Wise. The revision process is expected to continue throughout 2007.
Since the interim action was suspended, the current standard is now reinstated as written in the 2007 accreditation manual. However, that standard has two exceptions for EP 1, and surveyors will be interpreting them more liberally, says Kelly Podgorny, RN, MS, CPHQ, The Joint Commission's project director for the Division of Standards and Survey Methods.
The first exception allows for a prospective review to be bypassed if a licensed independent practitioner (LIP) controls the ordering, preparation, and administration of the medication. Now, the medication can be processed by a nurse, and the LIP will not be required to remain at the bedside while the medication is administered, which is different from The Joint Commission's previous position. However, the LIP must remain available to provide immediate intervention in the event that the patient experiences an adverse medication event.
The second exception is for urgent situations when the resulting delay could harm the patient, including situations in which the patient experiences a change in clinical status. The Joint Commission will now allow the LIP to define when a clinical situation is urgent.
[Editor's note: To access The Joint Commission's Urgent Bulletin — Update on Standard MM 4.10, go to: www.jointcommission.org.]