New JCAHO Medication Management Standards for 2004

Darryl S. Rich


Am J Health Syst Pharm. 2004;61(13) 

In This Article

Changes Related to Patient-Specific Information

JCAHO requires a written policy on the minimum patient-specific information that is available to persons involved in the medication management process because a lack of information is a major cause of medication-related sentinel events and medication errors. This is outlined in standard MM.1.10 (formerly TX.3.5.3) Patient-specific information is readily accessible to those involved in the medication management system. The minimum required information is listed in Table 2 . Access to this information facilitates continuity of care, creates an accurate medication history and current medication profile, and helps ensure safety in the medication management process. Inclusion of relevant laboratory test values in the minimum required information is noteworthy because it represents recognition of the importance of access to this information by pharmacists and other health care professionals. Access to certain patient-specific information may be necessary, depending on the medication and patient situation (e.g., weight and height for medications dosed by weight or body surface area, pregnancy and lactation status for medications that cross the placenta or are excreted in breast milk).

The patient-specific information must be accessible when needed, except in emergency situations when time does not permit. To be accessible, the information must be present where the individual is performing medication management duties (e.g., in the pharmacy when the pharmacist is reviewing orders). Having the information in the patient chart on the floor is not considered accessible if the pharmacist reviews orders in the pharmacy. Questions have arisen about the Standards for Privacy of Individually Identifiable Health Information (known simply as the privacy rule), which was issued by the Department of Health and Human Services to protect the privacy of certain health information in implementing the Health Insurance Portability and Accountability Act. The privacy rule is not intended to restrict the access of patient-specific information to persons involved in medication management and is not acceptable as a reason for not meeting the intent of this standard.