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Complete IV order

We recently had our Joint Commission survey and were told that our IV orders were not complete. We had in the order the following - Patient name, physician name/signature, drug, concentration, rate (both basal and bolus), route - ie: Hydromorphone 1mg/ml via PICC line at 5mg/hr continuous with 2mg bolus every 10 minutes prn pain, max of 6/hr. Everything that our policy states it should contain. Joint stated that we had to have the amount and type of diluent and the type of pump it would be infused with. These are determined by the prescribing pharmacy, not the physician in our agency and the participating pharmacy agrees. Does anyone have any ideas/comments/suggestions for me in how to resolve this issue?

IV order

I assume from your description that the JC comments only applied to PCA pumps. Please correct me if I am wrong. I am also curious to read comments about this. I would strongly agree that the type and amount of any diluent for any med must be documented along with the type of pump being used. However I would also agree that this information is not decided by a physician's order. It is determine by many other factors such as drug stability and compatibility, and capital equipment purchases. Lynn Hadaway

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

IV order

You are correct - this was a PCA issue. However, I do not know if this would apply to other therapies such as antibiotics. We do require the type and amount of diluent on the MAR and each nursing visit record. I plan to argue the point when I meet with upper management on 8/31/09. Teresa Brummett

As a pharmacists, the type

As a pharmacists, the type and amount of diluent used for final dilutuion of a compounded product is most often determined y the pharmacist as that person has best knowledge of the stability and compatibilty issues associated with such a decision.
Mike Kirkbride, Pharm D

Chris Cavanaugh
The JC's role is to be sure

The JC's role is to be sure the standards of care are met and the facilities policies are being followed consistantly across the facility. Did they site where in either their standards or in your facilities policies it states that the order needs to be written in that way? It is not something I am familiar with in their standards. When challenged or "dinged" by the JC, do not be afraid to ask for clarification from them, they make mistakes too! Often, it is only the surveyors there at the time that can explain their position.

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

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