ACEP Responds to JACHO RE: First Dose

From ACEP:

Joint Commission Reinstates First Dose Medication Review
April 13, 2007

Medications administered in an emergency department must once again be reviewed prospectively by a pharmacist, according to a notification sent to hospitals last week by the Joint Commission. But a conversation with the Joint Commission president indicates that the reversal may not be permanent.

ACEP President Brian Keaton, MD, spoke with Dennis O’Leary, MD, the Joint Commission president, on April 13. According to Marilyn Bromley, RN, Director of ACEP’s EM Practice Department, Dr. O’Leary indicated that he would convene an internal task force to revisit the many concerns presented to the Joint Commission.

“Dr. O’Leary suggested a conference call and we’re anticipating some action on this issue in the next several weeks,” Ms. Bromley said.

ACEP is working with the American Academy of Emergency Medicine (AAEM) and the Emergency Nurses Association (ENA) to present a united and unwavering opposition to this potentially detrimental accreditation standard.

The Joint Commission’s latest action reverses an interim action that allowed medications to be retrospectively reviewed by a pharmacist within 48 hours. Read the Joint Commission’s notification to hospitals here.

In May 2006 and January 2007, ACEP, AAEM and ENA jointly expressed their concerns about the Joint Commission’s standard requiring pharmacists’ prospective review in the ED. In addition, the American Medical Association approved a policy earlier this year opposing the requirement of first dose review by a pharmacist.

ACEP believes the standard poses a challenge to patient safety. Several ACEP Board members said the potential delay in patient care caused by a pharmacist review could be far more harmful than the amount of medication errors in the ED, the Joint Commission’s stated reason for the standard.

As the situation unfolds, ACEP will continue to keep its members up-to-date with the latest information.