Specifically timed doses (e.g., antibiotic for surgical patient to be given a specified amount of time before incision, drug desensitization protocols).For the purpose of ISMP’s guidelines that follow, scheduled medications DO NOT include: Scheduled medications include all maintenance doses administered according to a standard, repeated cycle of frequency (e.g., q4h, QID, TID, BID, daily, weekly, monthly, annually). Please keep in mind that the policies and procedures developed by acute care organizations using these guidelines will require flexibility of the goals for timely administration, as appropriate, to accommodate the additional time needed to learn to operate new medication-related technologies. However, the details may differ from one organization to another based on differing patient populations and medication systems, including available technology. In general, the guidelines represent a safe, effective, and efficient approach to timely administration of scheduled medications. An interdisciplinary team with adequate nursing representation needs to translate the guidelines into facility-specific policies and procedures. The guidelines are not standards or evidence-based practices that have been proven by scientific studies, but they have been vetted by hundreds of medication and patient safety experts hospital medication safety teams professional nursing, pharmacy, and respiratory therapy organizations The Joint Commission hospital pharmacists and frontline nurses who bear ultimate responsibility for administering medications in a timely manner. The guidelines are intended to be used as a resource when acute care organizations develop or revise policies and procedures related to timely administration of scheduled medications. These guidelines are applicable ONLY to scheduled medications (see definition section). However, given widespread support for these more reasonable and clinically appropriate guidelines, we hope CMS surveyors will allow hospitals to justify their carefully considered policies and procedures regarding timely medication administration using these guidelines to anchor the process. While delays in administering certain time-sensitive medications can also result in harm, a one-size-fits-all, inflexible requirement to administer all scheduled medications within 30 minutes of the scheduled time is a precarious mandate given that relatively few medications truly require exact timing of doses.ĬMS staff have requested a copy of the final guidelines, and based on our conversations with them, we are optimistic that positive changes will be made to the current “30-minute rule.” For now, hospitals will still be held accountable for the “30-minute rule” in the CMS Interpretive Guidelines. Many nurses reported feeling great pressure to take shortcuts to comply with the rule, which have led to errors, some harmful. The nurses who responded to the survey made it clear that changes to drug delivery methods and gradual increases in the complexity of care, number of prescribed medications per patient, and number of patients assigned to each nurse have made the long-standing CMS “30-minute rule” error prone. The Institute for Safe Medication Practices (ISMP) developed these Acute Care Guidelines for Timely Administration of Scheduled Medications after conducting an extensive survey in late-2010 involving almost 18,000 nurses regarding the requirement in the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation Interpretive Guidelines to administer medications within 30 minutes before or after the scheduled time.
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