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Examining the six steps of the medication process
In light of so many providers having difficulty meeting the standard of care for medication administration, the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, is taking action. One of its 2004 national patient safety goals is to improve the safety of using high-alert medications. In addition, updated medication standards from the Joint Commission focus more on medication processes as a system than on individual standards, says Michael Jarema, associate project director of the Division of Standards and Survey Methods at the Joint Commission.
For all surveys that take three days or longer, surveyors will walk through the six steps of medication process:
1. Selection and procurement: This is the process by which the organization decides which medications to have available and the process by which it obtains medications, including what to do if there is a shortage of a medication.
2. Storage: The provider addresses issues of medications that sound alike and look alike, as mentioned in the National Patient Safety Goals, including control of medications.
3. Ordering and transcribing: This step of the process includes consideration of computerized physician order entry, verbal orders, and written orders. It covers approved abbreviations, use of generics, indications for use, precautions, and 13 orders that require special attention, including an incomplete or illegible order.
4. Preparing and dispensing: This area covers preparation, issuance, and accountability for doses of a prescribed medication by a pharmacist or other authorized individual. It includes review of medication orders for appropriateness, safe preparation, labeling, dispensing practices, and medication recalls.
5. Administering: The standards addressing this part of the 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.
6. 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 to be a 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 pre-op, they may go to that area and talk to staff about storage and other safety issues, he explains.
Also, the Joint Commission requires facilities to have a regulation that provides a process for a nurse to contact a physician when an order isn’t legible or is the wrong dose, adds F. Dean Griffen, MD, FACS, surgeon at the Highland Clinic at Shreveport, LA.