Joint Commission Survey Follow-up
By Chris Price, MD
As many of you are aware Banner Gateway Medical Center underwent a Joint Commission Accreditation survey recently. Overall we did an outstanding job and could not have done it without you. As with every process there are always areas for improvement and we hope to fine tune the following issues which were identified:
Medication Management – Therapeutic Duplication of Orders
- Findings indicate unclear medication orders in several instances.
- Medications in the same class were ordered for a patient but it wasn't clear which ones should be used and when. For example, toradol was ordered for pain level of 1-3 and Lortab liquid was used for "pain PRN". Other times antiemetics were written for PO and IV. Though it appears obvious when nursing should be using one versus the other, we need to be specific and precise in our instructions. The reality of it is that these orders put the nurses at risk for practicing outside their scope.
- Therapeutic duplication, without clear distinction regarding which medication is used and when are incomplete orders and will require clarification. You may receive phone calls requiring clarification of orders.
It is acceptable when writing orders to:
- write different pain ranges for each of the medications so they do not overlap
- write to start with one medication first and use the second if the first one does not work
- state to use intravenous medications until taking oral and then to switch to the oral medicine
- indicate in the order comment section which medication to give first.
- Findings indicate there was no documentation that a discussion had occurred with the patient, family or MPOA regarding end of life/DNR status.
General medical staff rules and regulations require documentation of the discussion as well as the status.
- Findings indicate there was no documentation regarding the reason for the restraint.
- General Medical Staff Rules and Regulations require documentation within 24 hours – of the need for restraint and authentication of the previous order if it was a verbal order.
I want to thank you again for your help making this survey such a success.