Archive for October, 2008
CMS Clarifies Use of Standing Orders and Signing of Order Sets
CMS has clarified its position on the use of standing orders in hospitals. The use of standing orders must be documented as an order in the patient’s medical record and signed by the practitioner responsible for the care of the patient, but the timing of such documentation is not to be a barrier to effective emergency response, timely and necessary care, or other patient safety advances. This means a standing order can be implemented without the physician expressly providing the order at the time, and the order can be obtained at a later date. These standing orders must be approved by the medical staff, and CMS does voice concern about exceeding scope of practice, so it is advantageous to make sure the medical staff has approved the standing orders for use by qualified and competent care providers, with the licensed independent practitioner validating the standing order in writing as soon as practicable. Also CMS clarified Signatures on Order Sets saying the last page must be dated and signed and any changes to the order set (other than checking which boxes apply, indicating type of treatment) initialed by the physician. Standing Orders in Hospitals – Revisions to S&C Memoranda
2008 FAQ enhances requirements for Look Alike-Sound Alike Drug Management
In the 2008 (March 2008) FAQ regarding NPSG 3C managing Look Alike, Sound Alike medications. The FAQ requires that error (interchange error) prevention stragegies should occur at all phases of medication management. This would include procurement, storage, transcribing, ordering, dispensing and administration. The FAQ continues to say that in addition to interchange error protection, prevention methods should include differing strengths of drugs. Therefore, staff involved at all levels of medication management processes should know the error prevention stragegies put into place to protect against interchange and dosing errors. Previously, many organizations focused on the Pharmacy and the site of administration only. Now organizations are to expand their scope to assure prevention strategies are implemented at each step of the medication management processes.