Magazine article Drug Topics

Joint Commission Flip-Flops on ED Medication Reviews

Magazine article Drug Topics

Joint Commission Flip-Flops on ED Medication Reviews

Article excerpt

Effective Jan. l, 2007, the Joint Commission issued an interim action for Standard Medication Management (MM) 4.10, EIement of Performance (EP) l for critical-access hospitals and hospitals. The interim action did not require a prospective review of medication orders in the emergency department (ED) if a pharmacist conducted a retrospective review of medication orders within 48 hours. However, on April 9, 2007, the Joint Commission notified hospitals that the interim action was suspended immediately and indefinitely-that medications administered in an emergency department must once again be reviewed prospectively by a pharmacist.

"I agree with the Joint Commission's attempt to promote safety, but I am pleased it rescinded the interim action because logistically it did not work," stated Mitch Sobel, pharmacy director at Saint Michael's Medical Center in Newark, N.J., and president of the New Jersey Society of HealthSystem Pharmacists.

The intérim action was issued following concerns from emergency departments regarding Standard MM 410, EP1 in the "Medication Management" (MM) chapter. Organizations found themselves consistently out of compliance with the requirements for a pharmacist to review medication orders before dispensing and administering the medication in the ED due to factors such as urgent patient situations, time, work flow constraints, and manpower. "It is tough for any institution to add services to any emergency department as well as have [physical] space available," stated George Delgado Jr., Pharm.D., coordinator of emergency services and emergency medicine clinical pharmacy specialist at Detroit Receiving Hospital and University Health Center. Joint Commission thought the interim action would prevent delays while retaining an R.Ph.'s involvement through a retrospective review.

Robert Wise, VP, Joint Commission, standards and survey methods division, said the interim action went into effect without a field check It would not have been approved if organization officials had understood that the requirement for retrospective review would cause so many problems.

While the Joint Commission revises Standard MM 4.10, the process for Surveying EP1 will be modified in the ED. In its communication, Joint Commission informed the hospitals that surveyors expect to see EDs complying with EP 1 for Standard 4.10 of medication management. In accordance with Standard 4. …

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