Caring for critically ill patients often requires nurses to use titrated medications, but understanding and implementing current order elements can create confusion for the clinician and risk for the patient.
In 2021, The Joint Commission clarified its requirements to provide leeway to clinicians for administration and documentation of rapidly titrated medications, along with minimum elements of a complete medication order.
For several months, AACN worked with The Joint Commission to clarify its medication management standard, which delineates required hospital policies for medication orders, including titrated medications. AACN leaders developed a strong, collaborative relationship with The Joint Commission and were at the forefront of providing input regarding interpretation of its medication management standard.
AACN will host a webinar on Jan. 20 that addresses the process one facility used to implement the requirements. The presentation includes recommendations for medication titration orders as well as block charting implementation and documentation.
In the video above from June 2020, AACN Chief Clinical Officer Connie Barden, MSN, RN, CCRN-K, FAAN, spoke with Dr. Robert Campbell, PharmD, director of clinical standards interpretation hospital/ambulatory programs at The Joint Commission, about the changes and updated requirements.
00:01 - Introduction by Connie Barden
1:54 - Overview of standards changes related to titrated medications
5:05 - Clarification of titrated medications covered by these standards
6:07 - Elements of a medication order specifically for titrated medications
7:16 - Clarification of TJC position on range orders
8:35 - Timing of changes and relationship to COVID-19
10:50 - Effect of these changes on previous citations by TJC
12:00 - Education and communication of TJC surveyors on new standards
13:20 - Interactions with surveyors during surveys
15.30 - Clarification of pausing vs. discontinuing IV titrated medications
18:00 - Synthesis of content by Connie Barden
19:20 - Explanation and discussion of block charting
20:48 - Summary by Dr. Campbell
21:58 - Closing remarks
To provide detailed information about the requirements, The Joint Commission has given AACN permission to publish, “The Joint Commission Clarifies Expectations for Implementing Medication Titration Orders” from the June issue of Joint Commission Perspectives. This article is under copyright and may not be republished without express written consent by The Joint Commission.
Block Charting During Rapid Titration for the Critically Ill Patient – This content, shared with permission by Inova Fairfax, is an overview for the use of block charting of titration of medications in the critical care setting with an example of clinically operationalizing this documentation process.
Titration of Continuous Infusion Medications in Critical Care Areas – This document, shared with permission by Temple University Hospital, is an example of a policy and procedure implementing The Joint Commission revised requirements including block charting.
AACN Clinical Community – AACN community sharing group for direct care nurses, charge nurses, clinical educators, advanced practice nurses and anyone else interested in connecting with their peers to discuss clinical practice topics.