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Re: JACHOFrom: ainsron (ainsron@sbcglobal.net)Fri May 12 12:00:10 2006
I can't comment on all of the issues, but we all face similar problems. The update on H&P's greater than 24 hours prior to surgery is something we are also struggling with. It is frustrating, but pretty simple to deal with, by simply writing a quick note that nothing has changed when the patient is waiting in preop. Simple as physicians, but not so simple for limited license practitioners, i.e., podiatrists, dentists, etc, who have their patients evaluated by a primary care physician preoperatively - often over a week before surgery. Is that physician required to write an update note in the chart before surgery, pretty hard to enforce? One solution I've heard is for the anesthesiologist's note be used to satisfy that requirement, however, they balk at the idea and technically, a H&P dictated by one physician cannot be updated by another physician, it would need more than just a quick note and assumes a higher degree of liability than the anesthesiologists want to accept. The issue with orders being written for specific conditions, such as prn pain, prn nausea, etc. rather than simply prn with the expectation that the nurses could use their judgment and issue the medication appropriately has been coming around for the last several years. The other requirement is that range orders cannot be written with more than one variable - you can write Morphine sulfate, 3 mg IV q4-6 hrs prn mild pain and or Morphine sulfate 5 mg IV q4-6 hrs prn moderate pain, but not Morphine sulfate, 3-5 mg IV q4-6 hrs prn moderate to severe pain. As physicians, we expect nurses to be able to use their professional judgment and understand what we want. JCAHO wants it to be "idiot proof," in order to avoid medication errors. I think writing multiple orders when one would suffice increases the risk of error. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Lynn Montgomery, MD Sent: Thursday, May 11, 2006 12:41 PM To: Multiple recipients of list OB-GYN-L Subject: JACHO Listers, The outstanding organization, JACHO, has stuck another blow in making the practice of medicine safer for all of us. In my hospital, these are the changes that have been mandated: -Before giving each patient their breakfast tray, each patient's hospital ID has to be looked at to verify their identity. -The kitchen on the Women's Unit had an industrial, commercial grade soup warmer that the cafeteria stocked with soup each evening for patients and staff. That has been removed because it is against JACHO regulations. -The kleenex boxes have been removed from the nurses stations and patient rooms because they are unsanitary and against JACHO regulations. -Despite patient admission and discharge meds being documented on H&P's, order sheets and prescription forms with duplicates, a separate form has to be included in the chart with all admission meds, all discharge meds and signed, not once, but twice by the physician. -Pre-op H&P's dictated greater than 24 hours prior to surgery have to be updated and signed a second time. -When writing for medications such as Phenergan, it is not sufficient to write "IV q3-4h prn", it has to be written "IV q3-4h prn for nausea and vomiting". Or better yet, you can't use "Dulcolax suppositories prn". It has to be "Dulcolax suppositories prn constipation"... These jerks have got to be sitting around a big table thinking of things to continue justifying their existence... Lynn
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