New JCAHO Medication Management Standards for 2004

Darryl S. Rich


Am J Health Syst Pharm. 2004;61(13) 

In This Article

Changes Related to Medication Administration

Standard MM.5.10 (formerly TX.3.6) Medications are safely and accurately administered. Policies and procedures must identify health care staff who may administer medications with or without supervision, consistent with organizational policies, laws, and regulations. Organizational policies may address qualifications by medication, medication class, or route of administration. For example, the administration of i.v. medications and cancer chemotherapy is restricted to staff with certain qualifications in some organizations. Organizational policies and procedures also must include guidelines for prescriber notification in the event of an adverse drug reaction or medication error.

Before a medication is administered, it must be verified as the correct medication by reviewing the product label and medication order. The medication administration record may be substituted for the medication order if there is a mechanism to verify that transcription of the order to the medication administration record is accurate.

JCAHO requires those who administer medications to verify the following: the medication is stable (based on visual examination for particulates and discoloration), the medication has not expired, there is no contraindication to administration of the medication (e.g., drug allergy), and the medication is being administered at the proper time in the prescribed dosage by the correct route. These verifications must occur at the time of administration in the location where the drug is being administered, as much as possible.

The patient or, if appropriate, the patient's family should be advised about any potential significant adverse reactions or other concerns about administering a medication before it is administered. For example, a patient receiving vancomycin might be warned about red man syndrome. This information allows the patient to self-monitor for such a reaction.

The nurse or person administering the drug should discuss any unresolved, significant concerns about the medication with the patient's physician, prescriber (if different from the physician), or relevant staff involved in the patient's care. This discussion should occur before medication administration.

Standard MM.5.20 (formerly TX.3.7) Self-administered medications are safely and accurately administered. If self-administration of medications is allowed in a health care organization, procedures must be in place to guide the safe and accurate administration of those medications and that address medication administration training and supervision and documentation of medication administration. Self-administration involves the independent use of a medication. Giving a dose of an oral medication to a patient who places the dose in his or her mouth and swallows it while a nurse watches is not considered self-administration. Persons who are not staff members who administer medications (e.g., a patient who is self-administering a medication, a family member who is administering a medication to a patient) should be given training and appropriate information about the nature of the medication to be administered, the method for administering the medication (dose or amount, frequency, and route), the expected actions and adverse effects of the medication, and the method for monitoring the effects of the medication (e.g., self-monitoring of blood glucose for a patient receiving an antidiabetic medication). Competency in medication administration must be determined before allowing persons who are not staff members to administer medications.