Joint Commission Proposes Change in Medication Management

The AAFP has voiced objections to a new medication management standard for hospital emergency departments proposed by The Joint Commission, the accrediting organization for more than 15,000 health care organizations and programs throughout the nation.

The Pharmacist Review of Medication Orders in the Emergency Department (5-page PDF; About PDFs) standard calls for hospital pharmacists to conduct retrospective reviews of emergency department medication orders.

In a March 28 letter to The Joint Commission, AAFP Board Chair Rick Kellerman, M.D., of Wichita, Kan., pointed out that the proposed revision would place a burden on physicians by mandating a "cumbersome review process."

Kellerman argued that hospitals already have review processes. He said the proposed requirement "would be above and beyond the typical peer review" to which the AAFP has no objections. However, the Academy strongly objects to retrospective pharmacist reviews of medication data because such reviews could take place days or weeks after a patient was seen in the hospital. At that point, the physician would be forced to postpone the current day's work to pull a chart and answer the pharmacist's questions, explained Kellerman in an interview with AAFP News Now.

"For those emergency rooms that are experiencing excessive delays in servicing patients, and for those that are facing upwards of several hours for a patient to be seen and cared for, these regulations would add additional delay," wrote Kellerman, adding that such delays "cannot be viewed as helpful in improving care or access to care."

Kellerman asked the commission to reconsider the original version of the medication standard that would allow hospitals "to continue to review medication administration in the emergency room as they feel is most conducive to safe and timely patient care."