Inpatient Medication (unit-dose) orders are permitted for Outpatients when the following 0000095728 00000 n
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when a component is missing from the drug . Medication frequency. There shall be a written practitioner's order in the resident's record for any prescription medication, over-the-counter medication, or dietary supplements administered to a resident. 0
Therefore, RNAO urges CNO to resolve this barrier to care by either: a) Revising the Medication Practice Standard to remove the requirement to include the purpose of a medication in an order to dispense; or 0000172011 00000 n
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Drugs authorized under the Interim Order are subject to all of the post-market reporting requirements in the Regulations with the exception of the Annual Summary Report and Case Reports requirement (C.01.018). 0000003584 00000 n
All health-system pharmacies have an obliga-tion to provide a review of medication orders that ensures safe medication use.1 When onsite pharmacist review is not available, health systems may determine that remote phar-macist review of medication orders is a suitable alternative. (exceptions include eye and ear drops, creams and ointments, liquid multivitamins), Range orders without objective measures to determine the correct dose, Nonformulary medications or drugs withdrawn from the market, Drugs for which a therapeutic substitution has been approved, Medication devices no longer available in the organization (e.g., syringe pump), Organization-prohibited orders and ambiguous blanket orders such as “take home meds” or “resume pre-op medications”, Exhaustive variety of analgesics, antiemetics, laxatives, antacids, bedtime sedative, antidiarrheal, and other medications by various routes to cover every possible scenario, “If...then’’ orders that inappropriately shift responsibility from the prescriber to the nurse or pharmacist to determine whether the order should be activated (e.g., give RhoGAM if indicated; if patient has condition “x” begin low-molecular-weight heparin; begin vancomycin if okay with infectious disease practitioner); orders are acceptable if the specific parameters are within the scope of practice and control of the pharmacist or nurse (e.g., begin the antibiotic after obtaining three blood cultures), Overlapping parameters to guide medication administration that make it difficult to interpret the correct directions (e.g., give “x” units of insulin for a blood sugar of 150-200 and “x” units of insulin for a blood sugar of 200-250), Contraindicated or potentially dangerous combinations of drugs (e.g., IV morphine and epidural HYDROmorphone/bupivacaine on the same order set, with boxes that allow both orders to be activated; drugs with known drug interactions), Medication typically contraindicated in the targeted population (e.g., aspirin on pediatric order sets), Identifies a champion of the order set (e.g., physician, nurse, or pharmacist) to help facilitate review by the end users of the order set, Considers any changes in drugs of choice and new devices since initial design or approval, Identifies and includes representatives in the review process from all areas that will use the order set (including remote facilities in multisystem, Makes substantiating documentation (e.g., clinical trial data, benchmarking data, national guidelines, prescribing information, professional standards, regulatory and accreditation standards) available to the reviewing committee/team and records the references in the minutes of the meeting(s) during which discussions take place, Conducts a verification process to ensure that all medications comply with recommended dosing based on current evidence-based literature, Captures and shares comments from reviewers during the review process with the committee/team responsible for approval, and incorporates comments into the order set as appropriate, Ensures approval of the order set by a standing interdisciplinary committee/team composed of physicians, nurses, pharmacists, and other allied health representatives (e.g., information services, respiratory therapy, dietary) who might use, carry out, or maintain the order set, Establishes a plan to communicate significant changes in the order set to all who will/could be using it regularly, Drugs with a new boxed warning that has not been addressed, Equipment no longer available in the organization, Schedules at least a biennial review of the order set to ensure that no more than 2 years have lapsed since last approval; some order sets may require more frequent evaluation and reapproval, Removes older version of the order set from use or access; provides or makes accessible the newer version to all affected areas (ideally online), Implements plan to communicate significant changes in the order set to all who will/could be using it regularly, Expresses IV/epidural doses in a manner that matches possible programming choices with infusion pumps (e.g., smart infusion pumps, patient-controlled analgesia pumps), Expresses rates of infusion per hour or per minute; avoids infusion rates that require unnecessary calculations (e.g., 600 mL over 8 hours vs. 75 mL/hour), Expresses electrolyte doses and additives to IV compounded products in a manner that matches the pharmacy and/or compounder order entry system, Uses rounded medication doses whenever clinically feasible according to the organization’s policies (e.g., doses of chemotherapy greater than 10 mg rounded to whole number doses; very small doses rounded to an amount that can be accurately measured and/or dispensed), Uses an approved, single, standardized format for all order sets, Includes prompts at the top of the form/screen for the patient’s body surface area (BSA) based on current weight and height (and the date the BSA was calculated along with prompts for updated calculation of BSA, when appropriate), Includes frequency of reweighing patient for calculation of proper dose, Defined regimen/protocol acronym and protocol number, Cycle number (e.g., prompt for cycle # __ of __, or cycle # 5 of 6), Individual single daily doses in mg/m2 or area under the curve (AUC) where appropriate and the final calculated dose in mg (or other dosing units) to be administered, Actual dates of administration for all days in course of therapy, Span of days for administration of a course of therapy, especially when a hyphen is used to express the days of therapy (e.g., days 1- 4), Verifies that daily doses of all prescribed analgesics do not exceed safe maximum doses if administered as frequently as prescribed; for example, acetaminophen doses do not allow more than 3 to 4 grams per day (by frequency of individual products or in combination with other products); total doses of all opioids limit the potential for toxicity if each is given as often as prescribed, Excludes potentially dangerous combinations of analgesics (e.g., IV morphine and epidural HYDROmorphone/bupivacaine on the same order set, with boxes that allow both orders to be activated), Includes the mg/kg dose (or mg/kg/hour, mcg/kg/min, or similar weight-based dosing formula) and the total calculated dose or a prompt for the prescriber to calculate and enter the total dose, Excludes potentially inappropriate medications for this population (e.g., Beers criteria), Provides online access of order sets to print in small quantities to avoid making repeated copies from existing copies, Limits the number of copies on clinical units to a 1-month supply to ensure that older order sets are not used after revision; for online order sets, copies are not printed before needed and stored on clinical units, Includes page numbers (e.g., page 1 of 2), A prompt for prescriber’s signature, printed name, and beeper or phone number (and ID number, if required) which is consistent with the standard format, Sufficient space to clearly activate desired orders (e.g., adequate space between check boxes to prevent intended check mark from marking more than one box; between orders that must be circled to activate), Sufficient space above, below, and between “fill in” prompts to prevent crowding of entries and avoid stray marks from interfering with other “fill in” prompts, Lines on the back copies of order forms if carbonless (NCR-no carbon required) paper forms are used (NCR forms are not recommended if orders are faxed or scanned to pharmacy; order copies may pick up inadvertent marks and are not as clear as the original order set). 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