C6 What a Pain! Meeting The Joint Commission Standards for As-Needed Medication Indications

Abstract

The purpose of this project was to eliminate therapeutic duplication of PRN orders in the electronic medical record (EMR) and improve interprofessional collaboration, education and safety surrounding PRN medications. Our organization lacked a standard approach to prevent therapeutic duplication. This was important for us to address since it is an important patient safety issue and violates The Joint Commission and Centers for Medicare and Medicaid Services compliance standards. The lack of clarity around medication orders resulted in inconsistent practices between nursing shifts and could cause misinterpretation of the providers' intent of therapy. Our organization created new as-needed reasons for key therapeutic classes with the assistance of all key stakeholders input. These new indications were then incorporated into new PRN order indications within the EMR system. Alerts were created for providers during order entry and for pharmacists during order verification of potential therapeutic duplication. Policy and collaborative practice enhancements as well as interprofessional educational materials and organizational campaign communications were created. Chart audits were performed pre- and post-implementation for the presence of therapeutic duplication. Post-implementation, an electronic survey of providers, nurses and pharmacists was done to ascertain if the changes made were positively impactful or not. Our results indicated that our organizational efforts were successful in improving patient safety and reducing therapeutic duplication without adversely impacting interprofessional workflow and processes.