at least temporarily.
Dear AAEM Members,
On May 17, 2007, AAEM, along with leaders from ACEP and ENA, met face-to-face with The Joint Commission (TJC) to relay our concerns with Interim Standard MM 4.10. I am happy to report that this has resulted in a positive and rapid change in The Joint Commission’s position. The latest ruling and interpretive guidelines can be found at
Essentially, a medication ordered by an emergency physician can be administered by an emergency nurse (or respiratory therapist) without pre-approval by a pharmacist as long as the emergency physician is immediately available to intervene should the patient experience an adverse reaction.
Tom Scaletta, MD FAAEM
Before this the rule wanted every medication checked by a pharmacist before it was administered, a stunning display of ignorance regarding how medicine is practiced and the realities of the numbers of pharmacists available to even do the job. To do the job were it a good idea, which it isn’t.
The link has the following:
The Joint Commission will now permit organizations to implement the two exceptions in Standard MM 4.10, EP 1 more broadly in order to minimize treatment delays and patient back-up. To clarify this position, each exception is addressed below emphasizing its implementation in the ED:
- Exception 1: “…unless a licensed independent practitioner controls the ordering, preparation, and administration of the medication.”
Implementation: When using this exception, medications ordered by a licensed independent practitioner in the ED can be processed, including administration of the medication, by a registered nurse or other licensed staff with medication administration responsibilities (e.g. respiratory therapist) in accordance with law and regulation. A licensed independent practitioner will not be required to remain at the bedside when the
medication is administered. However, the licensed independent practitioner must remain available to provide immediate intervention should a patient experience an adverse medication event.
- Exception 2: “…in urgent situations when the resulting delay would harm the patient, including situations in which the patient experiences a sudden change in clinical status.”
Implementation: When using this exception, urgent care situations will be defined by the licensed independent practitioner who is providing care to the patient.
Which is how it has been, and should always have been.