This member-only article appears in the November issue of Patient Safety Monitor Journal.
The Joint Commission’s 2019 Executive Briefings were held September 14 in New York City. The discussion on medication management was one of the most far-ranging, with questions on medication compounding, opioids and painkillers, and syringe use asked and answered. The man doing the answering was Robert Campbell, PharmD, a pharmacist with The Joint Commission’s Standards Interpretation Group.
The following Q&A from the briefings was lightly edited for clarity.
Q: My question is about titration and ranges. We have eight critical care units in our hospital. They don’t all agree on what the ranges should be. We’re also [using] an Epic electronic medical record (EMR), and when you create a titration order in the system, it changes everything for everybody. So if we can’t come up with a standard all the physicians can agree to in the EMR, it’s very difficult to use that to do titration in our critical care areas. How do we proceed?
Campbell: I think it’s important. I understand the rationale of the providers: An epinephrine drip on a cardiac post-hazard patient is much different than an epinephrine drip on a patient with brain damage.
There was a surveyor I knew who used to use this methodology of talking with the medical staff and teams that support the [titration] reporting. You standardize the process so that all titration orders must be met within these parameters, and then we’ll individualize those.
So you may have an “epinephrine/cardiac” [parameter] and an “epinephrine/neuro” [parameter in your EMR]. That’s OK to do. So when they pull up medication orders, it pulls up those parameters for them, then other providers in the other disciplines, it brings up what their [titration range] would be.
Standardize the process for building, individualize the care, then put the onus on the builder of the IT infrastructure to make that happen.
Q: You have a slide that says “education alone will not meet the intent” when it comes to non-pharmacological approaches to pain. Can you talk about what might meet the intent?
Campbell: The slide you’re talking about has to do with staff education on pain management.
If you look at our R3 report, one of the things we say is that you must have resources available to the staff. So a lot of times people have used annual education to make those resources available to the staff. That’s not what we’re saying here.
What we’re saying is that you must have those resources readily available so they can access them on the unit. On your extranet site you could have a pain management core, a log of some sort, the resources you want your staff to have—for example, the pros and cons of the non-pharmacological approaches your hospital is going to use, what your guidelines are for opiates, pain control for opiate-dependent patients, what positions in your hospital can do pain management. If you have a pharmacy staff, [this core should have] the resources they would need like dosing medications and pharmacology.
Q: For environmental persons that clean certain sterile areas, in addition to education and training on the process for cleaning, is a competency required or recommended?
Campbell: Required. Not only do they have to do the competency on cleaning, they have to do a competency on garbing. Because it makes no sense for the pharmacy technician who can’t wear makeup or jewelry, or have dandruff or a sunburn who has to [wash] up to go into a room and the person cleaning the room doesn’t have to do any of that.
If you’re going to have your environmental services involved, they need to understand all the components. Because if they don’t clean it properly or go into that room and introduce particles inadvertently, it takes away the entire purpose of what you’re trying to achieve.