From: David Collette
Sent: Monday, October 9, 2017 3:17:24 PM
Subject: PRN orders - duplication and indication
Attachment:
Duplicate Medication Orders 9-16
Duplicate Medication Orders Guidelines-Cheat Sheet 08-2016 DRAFT

 
A couple of our pharmacy students, Emily Arzonico and Hallie Knight, recently complete an audit of 105 charts at HHMain and 33 at HHWC for duplicate PRN med orders and inclusion of indication(s) with PRN orders. They only looked at iCare entries that had been verified by a pharmacist, NOT physician orders. There were some improvement in a few of our numbers, but there was still some opportunity for further improvement. Here are some details:

    * 17% of charts (equally distributed at HHMain and HHWC) had no indication listed with the PRN order (this included tramadol, artificial tears, albuterol, chlorhexidine, promethazine, and sodium chloride nasal spray). Our policy (and TJC expections) require that we include an indication with all PRN med orders, even if there is only one possible use.
    * 13% of charts (10% at Main, 24% at HHWC) had duplicate PRN meds with no instructions as to when to give one over the other (most common duplicates were for pain, constipation, nausea/vomiting, and eye moisture). TJC will cite this as "nurse prescribing" since a lack of instructions leads to the nurse deciding when to give one PRN med or the other and this is beyond their scope of practice.

I have attached our Duplicate Medication Orders and PRN Indications guideline as well as a "cheat sheet" for this process, both developed by Michele Durda. Duplicate PRN meds is a known focus of TJC and is one of the fastest rising RFIs in the Med Mgmt chapter.

Please review this information and let me know if you have any questions. DAVID

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David R. Collette, Pharm.D., FASHP
Operations Manager, Professional Services Huntsville Hospital Department of Pharmacy