Medication Orders are Written Clearly and Transcribed Accurately – Implementing Medication Management Standard 3.20 and National Patient Safety Goal 2b

Abstract

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Medication Management Standards and certain National Patient Safety Goals contain specific requirements aimed at promoting medication safety. Medication Management Standard 3.20 states, “Orders are written clearly and transcribed accurately.” National Patient Safety Goal 2b states, “Standardize a list of abbreviations, acronyms, and symbols that are not to be used throughout the organization.” After minimal success with educational interventions aimed at eliminating unacceptable abbreviations and obtaining indications for PRN (as needed) orders, Oregon Health & Sciences University (OHSU) instituted a hard stop; no orders containing an unacceptable abbreviation or PRN order without an indication were processed by pharmacy, and the prescriber was required to rewrite the order. After instituting the hard stop, the frequency of unacceptable orders decreased from 25% of all processed orders to 3%. Although the hard stop was very successful in terms of outcome, it caused workflow interruptions, and increased workload for pharmacy, nursing, and prescribers. Because of staff feedback, the hard stop has been modified to eliminate pages to physicians—unless the order is unclear. As a result, there has been an increase in the number of orders containing unacceptable abbreviations or PRN orders without an indication. Maintaining consistency in order writing is a process that requires continual attention.