If ever I needed a good shot of Bromo Seltzer it is now.
My nerves need soothing.
My head is pounding.
I have an acute case of acid reflux.
My blood pressure is sky high.
I’m not sick.
I did however, receive an email from the Emergency Nurses Association.
If you have ever considered joining ENA, now is the time.
They are on our side.
Somebody has to be.
JCAHO has finally crossed the line.
I present to you the latest in Stupid JCAHO Tricks, as described in an email sent to all ENA members.
On April 6, the Joint Commission rescinded the Interim Action for Standard MM.4.10 EP 1 for Emergency Departments. Therefore, in accordance with MM.4.10 EP 1:
“…prior to dispensing, removal from floor stock, or removal from an automated storage and distribution device, a prospective pharmacy review is expected for all medication orders unless a licensed independent practitioner controls the ordering, preparation, and administration of the medication; or in urgent situations when the resulting delay would harm the patient, including situations in which the patient experiences a sudden change in clinical status.”
Translation: before you are even allowed to remove a medication from your Pyxis or take down a bottle of medication from the shelf in your ER, the pharmacy has to review the order. Except when the resulting delay would hurt the patient.
JCAHO acknowledges the delay!
Am I missing something here?
Never mind the effect on already impacted emergency departments.
Never mind that the only “licensed independent practitioner” in an ED is the physician (or maybe a nurse practitioner or physican’s assistant). They will now have to “control” the ordering, preparation and administration of all medications the pharmacy can’t review.
I hate to be the one to break this to JCAHO, but some hospitals don’t have the luxury of a twenty-four hour pharmacy.
Never mind all those pain medications you order for patients with chronic back problems or migraines.
- You can’t touch that dial on the Pyxis until you are given permission by the pharmacy.
What about the patients that come in with a single-spaced 81/2 by 11 medication list that must be transcribed?
- Better write up that medication reconciliation form STAT, because the pharmacy won’t take the patient’s list. You have to fax them the official list for review. In my facility we asked if we could just copy the patient’s sheet and attach that to the form. Apparently this will occur about the same time as pigs begin to fly (I’m paraphrasing).
What if the pharmacy does not recommend giving the ordered drug (for whatever reason) and the doctor disagrees?
- Can the ED staff still give the ordered drug?
- Can the pharmacist actually override the physician’s ability to prescribe a specific drug?
How long before we have to fill out a special form to document an “urgent” situation if we do give medication before the review?
JCAHO, you told us we had to put locks on all the doors and we did. We thought it was stupid, but we did it.
Then you told us there must be a medication reconciliation form and almost every hospital I know of put the onus of this on the emergency room nurses. We think it is asinine. But we do it.
You told us we had ask about and document cultural beliefs on the chart. Every single patient I ask looks at me like, “What the heck are you asking?”. That mandate was useless. But we do it.
JCAHO, you may say “JUMP!” and the hospitals will say “How high, Master?” but the emergency departments will not.
The Emergency Nurses Association is in partnership with the American Academy of Emergency Medicine (AAEM) and the American College of Emergency Physicians (ACEP) to oppose this accreditation standard and this mandate will not stand.
Make no mistake. We will fight this with every fiber of our being.
Hell hath no fury like that of the nursing profession when pushed to the brink. And this time we and the doctors are of one mind, one opinion.
JCAHO, you are in danger of becoming a joke.
Your standards are ludicrous.
Enough is freaking enough.