Surveyors finding problems with medication standards
Surveyors finding problems with medication standards
Nearly half (43%) of hospitals surveyed in the first half of 2007 were not compliant with The Joint Commission's standard requiring medications be properly and safely stored, and 20% were non-compliant with the requirement for medication orders to be written clearly and transcribed accurately. Here are some of the non-compliant areas surveyors are finding for The Joint Commission's medication management standards:
• Processes to ensure medications are stored under suitable conditions for product stability.
"This is a requirement that we see organizations struggle with a fair amount," says Pat Adamski, RN, MS, MBA, director of The Joint Commission's Standards Interpretation Group. "That is probably the top issue that we see."
For example, if a medication needs to be refrigerated, the temperature must be monitored to ensure it's maintained within a certain range, by using a thermometer that alarms when it's out of range, or by doing a manual check every day. And if the temperature is out of range, there needs to be a consistent process followed for correction.
"If the temperature in the refrigerator goes out of whack, which does happen from time to time, do the staff involve the pharmacy to come up and evaluate whether the medication needs to be disposed of?" asks Adamski. "And what is done while you are waiting to get the refrigerator repaired, to make sure that the medication stays at its appropriate temperature and potency?"
Staff may forget to check temperature readings on a given day, but another more serious concern is failure to act if the temperature is documented as out of range.
"That is where people sometimes drop the ball," says Adamski. "The staff may be diligent about writing down a temperature, but if they don't pick up the phone and call somebody when it's out of range, they are defeating the whole purpose."
• Policies for what practitioners do after they obtain medications.
The organization needs to specify how a medication is stored between the time the health care practitioner retrieves a medication and when he or she administers it. "Sometimes physicians, nurses, and respiratory therapists like to put medication into their lab coat or uniform pockets or storage pouches. If the organization allows that, we want to know how they assess the process to make sure the security and stability of the medication is maintained, and that any infection control issues are addressed" says Adamski.
• Making sure that expired, damaged or contaminated medications are segregated.
"Those medications need to be kept away from all the other medications the staff are going to use, until they can be removed from the hospital," says Adamski.
• Removal of concentrated electrolytes from patient care units.
"Only in very specific situations are they allowed to be there, because of the potential for safety issues if an electrolyte is administered in its concentrated state and not diluted," says Adamski. "We took care of that a couple years ago with a National Patient Safety Goal, but now that it's back in the standards, every now and then we'll see it scored."
• Policies and procedures for medication orders.
"Whether or not the organization allows certain things must be clearly identified, so staff know exactly what the expectations are," says Adamski. For example, policies must state whether an indication for use must be within the medication order itself, or if it can be documented anywhere within the medical record. Special precautions for look-alike, sound-alike drugs must be identified, and processes must be defined for staff to follow if they can't read an order because it's illegible.
"Then, we want the organization to weigh in on whether they will allow certain types of medication orders, and if they do, we want to know how they manage those processes," says Adamski.
For instance, a policy for range orders may not give staff enough guidance for when to give specific dosages. "Or sometimes there is an issue with the titration of the medication — what allowance do the staff have to titrate a dose up or down, and is that within their competency skill set? Also, blanket reinstatement orders can never be allowed, and that must be clearly defined," says Adamski.
Most of the time, however, policies are specific enough — the problem is that they aren't being followed all the time. "Occasionally we will come across organizations that have not defined one or more of the requirements, but generally speaking, they have a pretty robust set of medication management policies," says Adamski. "But there is a lot of opportunity for staff, being human beings, to miss an aspect of a policy and procedure. That's what we see most often scored in this standard."
Adamski recommends using standard MM 8.10, which requires evaluation of the entire medication management system, to identify points where your organization may be vulnerable and drive your data collection efforts.
Review occurrence reports with risk managers, and ask frontline staff what procedures they find problematic. "It could be that the policy itself needs to be revised," says Adamski. "If people don't follow a policy, there is usually a reason. It could be totally impractical in terms of their work flow. Or when the policy was developed things were different, and it's never been updated."
Assessing compliance with policies is an area where many quality improvement initiatives fall short. "The organization may develop a wonderful set of policies, and have everybody sign a piece of paper saying that they have read the policy and will follow it — and then they stop," says Adamski. "They don't go back to see what is really happening — if staff are really following the policy. This is one of the biggest problems I see."
You can do this by interviewing staff, performing observations or doing random checks, in order to "close that PI loop" to evaluate whether a policy is being implemented as intended, says Adamski.
The Joint Commission has revised its medication management standards through a Standards Improvement Initiative in order to make them easier to understand, but the requirements will essentially remain the same, reports Adamski. "The intent is to get rid of a lot of the jargon and make them much clearer for the organizations," she says.
Nearly half (43%) of hospitals surveyed in the first half of 2007 were not compliant with The Joint Commission's standard requiring medications be properly and safely stored, and 20% were non-compliant with the requirement for medication orders to be written clearly and transcribed accurately.Subscribe Now for Access
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