New JCAHO Medication Management Standards for 2004

Darryl S. Rich


Am J Health Syst Pharm. 2004;61(13) 

In This Article

New Standards Related to Ordering and Transcribing

Standard MM.3.10 Only medications needed to treat the patient's condition are ordered. This new standard requires a documented diagnosis, condition, or indication for use for each medication ordered. The documentation need not be part of the medication order, but it must be in the patient medical record. This requirement should not pose a problem for most medications ordered, but it will be problematic for prescribers who automatically order certain medications (e.g., acetaminophen, docusate sodium) for every patient, regardless of the individual's specific needs, or for prescribers who reorder medications used before admission without knowing why they were prescribed.

Standard MM.3.20 Medication orders are written clearly and transcribed accurately. This new standard was developed to reduce the potential for error and misinterpretation when orders are written (or orally communicated) and transcribed. This may be the most difficult standard with which to comply because of the many detailed requirements outlined in the elements of performance and because physician compliance is required. JCAHO requires written policies that address the required elements of a complete medication order (e.g., drug name, dosage form, strength or concentration, dosage, and administration route, frequency, and duration). These should be consistent with law and regulation—both pharmacy and nurse practice acts. Actions to take when medication orders are incomplete, illegible, or unclear should be outlined in organizational policies.

Written policies must outline when generic or brand names are acceptable or required as part of a medication order, and policies should describe any special precautions or procedures for ordering drugs with look-alike or sound-alike names. Policies also must specify if and when the indication for use is required on a medication order. Although it is possible to comply with standard MM.3.10 by putting the indication for use somewhere in the patient medical record other than in the medication order, the organization may want prescribers to specify the indication for use as part of the order for certain medications (e.g., sound-alike and look-alike drugs, high-risk or high-alert medications associated with medication errors, sentinel events, abuse, or toxicity). The same is true of requiring both generic and brand names for such products. Policies should outline these organizational requirements.

Organizational policies must also specify the acceptability and special required elements of certain types of orders ( Table 3 ). The organization must review and update preprinted order sheets periodically. Organizational policies must define in writing when weight-based dosing is required for pediatric patients.

The organization must have policies that minimize the use of telephone and other oral orders as much as possible. Finally, JCAHO specifically requires policies prohibiting the use of blanket reinstatement of previous orders, such as "resume preop medications" or "continue home meds." Each individual medication order must be written.