More JACHO Crap

[docB]

---

Members don't see this ad.

In the ongoing attempt to eliminate medical errors by making it impossible to actually deliver any healthcare the JACHO "no abbreviations" campaign has gone off the deep end. I just got a memo from one of my hospitals saying that due to the JACHO mandate we can't write range orders anymore. It is now forbidden to write:
Morphine 1-5 mg IV q4 hours PRN pain

We now have to write:
Morphine 2 mg IV q 4 hours PRN mild pain (1-3/10)
Morphine 3 mg IV q 4 hours PRN moderate pain (4-6/10)
Morphine 5 mg IV q 4 hours PRN severe pain (7-10/10)

Now I write morphine orders about 30-40 times per day. I figure that having to write all that silliness out will keep me from seeing about 1 additional patient per shift. So in that regard they are achieving thier goal of decreasing the amount of healthcare delivered.

 

[sdn1977]

In the ongoing attempt to eliminate medical errors by making it impossible to actually deliver any healthcare the JACHO "no abbreviations" campaign has gone off the deep end. I just got a memo from one of my hospitals saying that due to the JACHO mandate we can't write range orders anymore. It is now forbidden to write:
Morphine 1-5 mg IV q4 hours PRN pain

We now have to write:
Morphine 2 mg IV q 4 hours PRN mild pain (1-3/10)
Morphine 3 mg IV q 4 hours PRN moderate pain (4-6/10)
Morphine 5 mg IV q 4 hours PRN severe pain (7-10/10)

Now I write morphine orders about 30-40 times per day. I figure that having to write all that silliness out will keep me from seeing about 1 additional patient per shift. So in that regard they are achieving thier goal of decreasing the amount of healthcare delivered.

I can appreciate your frustration....I need to input all those individual orders into the computer exactly so the nurses can get the drug from pyxis. I don't like it & don't necessarily agree with it, but I understand the reasoning behind it. The problem, at least within the facilities I have worked in, was the nurse would give whatever dose she/he wanted - sometimes it resulted in underdose or overdose without documentation of justification of the dose. (JCAHO is all about documentation)

So...now, the nurses have set parameters to describe pain at 1-3, 4-6, etc..they document what they observe then give the dose that corresponds. Still - based on the same judgement as before - it just forces them to document.

We have gotten around this by developing standard orders - preprinted - so all you do is sign them. For example...docB's vaginal postpartum, docB's ORIF post op, docB's post op appy...you get the idea. These also have all the other routine orders - dss, apap, etc. Then, in the pharmacy, we have all these loaded in the computer & its 2 or 3 keystrokes to get them input...voila - the orders are there & everyone (except you 🙁 ) is happy!

 

[DOmojo]

couldn't agree with you more 1977. This is a much needed improvement in patient tx and care. By the way docb, it's JCAHO. You should have the process improvement team at your hospital look into implementing standard order forms for most of your pharm orders docb.

No offense meant here... but honestly, as bad as most docs write, most hospital orders... labs, pharm, imaging, dietary, etc. need to be on standardized forms of some sort for the most frequently occuring things. You think it takes a lot of time for you to write it out? I spend a major part of my day helping the nurses on the floor decipher the poorly written orders not only for the patients you may see, but for a large portion of the patients all the other docs see as well--now that sucks big time!!

 

[docB]

couldn't agree with you more 1977. This is a much needed improvement in patient tx and care. By the way docb, it's JCAHO. You should have the process improvement team at your hospital look into implementing standard order forms for most of your pharm orders docb.

No offense meant here... but honestly, as bad as most docs write, most hospital orders... labs, pharm, imaging, dietary, etc. need to be on standardized forms of some sort for the most frequently occuring things. You think it takes a lot of time for you to write it out? I spend a major part of my day helping the nurses on the floor decipher the poorly written orders not only for the patients you may see, but for a large portion of the patients all the other docs see as well--now that sucks big time!!

You can't create a standardized order for everything. If you try you'll just wind up trying to pound round patients into square pegs to everyone's detriment. In any case you guys will be used to this because you trained with these requirements. For me it's just another major headache that makes moving patients through the ED take longer. Some day you guys will get some hair brained new mandate handed down to you that will annoy you to no end too. Hard to say when but sooner or later and I'd bet on sooner.

The last thing I would want to do is get some "process improvement team" involved in anything. It was a committee of useless bureaucrats that came up with this stupidity in the first place.

Ultimately this will most likely result in me not writing any orders. I can dump it on the admitting docs by writing to "call for orders." That means those patients won't get pain meds or whatever and their workups will be delayed but as no medical care is being delivered no mistakes will be made. I just don't have time to write whole paragraphs for simple orders when there are so many charts to be seen in the rack.

BTW you’ll have to forgive the typo. When you’ve been through as many site vistis as I have you just start calling them “those bastards.”