Joint Commission Finding: Inpatient Therapeutic Duplication

SITUATION

During our Joint Commission survey, a surveyor found a hospitalized patient that had an order for both Dilaudid and oxycodone for severe pain.  There were no administration instructions for when to use one over the other.

BACKGROUND

Therapeutic duplication occurs when providers order more than one medication for the same indication.  While this is an acceptable practice, there must be clarity sought to determine when one agent should be administered over another, if both agents are to be given concurrently, or if one therapy was to replace an existing therapy and wasn't discontinued properly.  

Therapeutic duplication is most commonly seen in orders for analgesics and anti-emetics but occurs in other drug classifications as well.

ASSESSMENT

In this case we discovered that the ACS order set was used, and the provider had a version of the order set saved that did not include the instructions for which medication to use first.

RECOMMENDATION

Please make sure that your saved versions of order sets include administration instructions if ordering medications for the same indication.

Be on the lookout for an alert when opening your version of an order set that has been updated.  It will indicate which orders were revised and request that you delete your outdated version of the order set and create a new one if desired.  

Thank you for your help with preventing future therapeutic duplication findings.