Hospitals throughout the United States are struggling with an issue that the Institute for Safe Medication Practices (ISMP) recently highlighted. Certain CMS requirements (see page 175 in linked document) for hospitals to administer medications within 30 minutes of their scheduled time found significant variances due to many factors.

According to an APhA briefing document, the ISMP survey conducted in July/August 2010 identified nursing’s inability to adhere to the 30-minute rule on medication administration and indicated shortcuts were being taken by nurses that could expose patients to unsafe situations in an effort to comply with the rule. Nurses commented that the primary emphasis on timeliness restricts their use of clinical judgment and critical thinking to make decisions appropriate to the needs of patients. ISMP has provided CMS with survey results, and has adopted proposed revisions to the guidelines that it plans to present to CMS for consideration. Further, ISMP is asking for comments on this topic by February 15, 2011. We want to know what you think.

Here are some considerations, according to the APhA briefing document.

The issue as framed by ISMP focuses on the ability of nurses to administer medications according to the prescribed schedule. The issue is of concern to pharmacists, however, because pharmacists are involved in overseeing and influencing the medication use system. The ISMP draft does not address the causality of mistimed doses (ineffective information technology systems, design of hospital processes not aligned with expectations for those processes, insufficient staffing in the pharmacy or with nurses and support staff).

Additional pressures will be placed upon pharmacy to expedite review processes and potentially shortcut their processes in order to help nurses meet the 30-minute timeframe. This could place patients at risk. Also, incentives to the institutions from CMS and other payers do not adequately support the human and system resources within nursing and pharmacy needed to meet the 30-minute timeframe.

APhA supports advocacy for changes in the CMS guidance. APhA is compiling comments and would appreciate any input you might have that we can use. Input we get will be blinded. Please send comments by February 11, 2011, to pharmacytoday@aphanet.org.