New JCAHO survey process addresses medication errors

In light of so many providers having difficulty meeting the standard of care for medication administration, the Joint Commission on Accreditation of Healthcare Organizations is taking action.

One its 2004 national patient safety goals is to improve the safety of using high-alert medication. In addition, newly organized medication standards from the Joint Commission put more focus on medication processes as a system, rather than individual standards, says Michael Jarema, associate project director of the Division of Standards and Survey Methods at the Joint Commission. For all surveys three days or longer, surveyors will walk through the six steps of medication processes:

  • Selection and procurement: This is the process by which the organization decides what medication to have available and the process by which it obtains medications, including what to do if there is a shortage of a medication.
  • Storage: The provider addresses issues of medications that sound alike and look alike, as included in the national patient safety goals, including control of medications.
  • Ordering and transcribing: This area includes consideration of computerized physician order entry (CPOE), verbal orders, written orders, etc. It covers approved abbreviations, use of generics, indications for use, precautions, and 13 orders that require special attention, including an incomplete or illegible order.
  • Preparing and dispensing: This area covers the preparation, issuance, and accountability for doses of a prescribed medication by a pharmacist or authorized individual. It includes review of medication orders for appropriateness, safe preparation, labeling, dispensing practices, and medication recalls.
  • Administering: The standards addressing this process cover giving a prescribed dose of a medication to a patient and describes safe administration processes such as verifying the medication, dose, route, time, and patient.
  • Monitoring: The standards addressing this process within an organization’s medication management system focus on the responsibility for monitoring effects of medications and the organization’s response to actual or potential adverse drug events and medication errors.

The surveyors might pinpoint a specific medication and "walk it through" the organization, Jarema says. They may ask, "How would you determine how you’re going to use this drug in your facility? What are storage issues? How do you train staff?" For new medications, they might ask, "Does this medication require anything unique?" Surveyors might pull a patient’s chart and ask about any medications the patient is taking that are considered high risk, such as warfarin. They might ask staff, "How is the medication approved for use in your organization? How did you decide to use it? How frequently do you review the medication you’re using? How do you know providers are competent to use them?" If surveyors see a drug is administered in a specific area, such as the pre-op area, they may go to that area and talk to staff about storage and other safety issues, he explains.

Also, facilities are required by the Joint Commission to have a regulation that provides a system for a nurse to contact a physician when an order isn’t legible or it’s the wrong dose, adds F. Dean Griffen, MD, FACS, surgeon at the Highland Clinic at Shreveport, LA.