Background Information: National Guidelines and the Joint Commission

1. Background Information:National Guidelines and the Joint Commission

2. Safety and efficacy of HDS use • Little is currently known about the safety and efficacy of HDS use in inpatient setting. • While many HDS are safe, some cause side effects or interactions with patients’ medications • Patients often want to use own HDS during hospitalization (Beal, 1998; Norstrom, 2002).

3. “Home Supply” HDS use • This practice of using a “home supply” makes identification and reconciliation of HDS use extremely important. • Due to risks of HDS-drug interactions or special risks encountered during surgery • e.g. interference with hemostasis, interactions with sedatives or anesthetic agents (Boyer, 2002).

4. Guidelines for HDS use • Currently, no universally accepted guideline for managing patients’ HDS exists. • However, • Joint Commission Accreditation of Healthcare Organization and • American Health Systems Pharmacists offer standards and guidelines on the use of HDS in hospitals • (Kroll, 2004).

5. Joint Commission Definition of “Medication” • In the Joint Commission Comprehensive Accreditation Manual for Hospitals, a medication is defined as: “any prescription medication, sample medication, herbal remedies, vitamins, nutriceuticals, over the counter drugs, vaccines, diagnostic and contrast agents, used on or administered to person to diagnosis, treat, or prevent disease or other abnormal conditions...” (JACHO, 2004). • Therefore, HDS is considered and shall be treated as any other medication for a patient.

6. Medication Standards • Joint Commission expects health systems to manage HDS products with the same diligence and care given to any prescription medication brought into the hospital by patients and their families. • All HDS should be subjected to medical staff review and approval and governed by institutional policies • (Walker, 2000).

7. Medical Reconciliation Act • Joint Commission's National Patient Safety Goal #8 - Medical Reconciliation Act • requires documentation of any patient use of herbal remedies, vitamins, nutriceuticals, over the counter drugs, just like any other medication • This is a standard that applies to all accredited hospitals in the United States.

8. Resources to explore… • Here are some resources for you to explore regarding this subject: • Joint Commission’s Enhanced Medication Safetyhttp://www.jcrinc.com/Enhanced-Medication-Safety/ • Joint Commission’s National Patient Safety Goalshttp://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/ • Massachusetts Coalition for Prevention of Medical Errors, Initiativeshttp://www.macoalition.org/initiatives.shtml#3

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