Background: For several years, TJC has required hospitals to monitor a patient's response to the first dose of a new medication. The standard is MM.07.01.01 EP 2:

"The hospital monitors the patient's response to medication(s) by taking into account clinical information from the medical record, relevant lab values, clinical response, and medication profile. Note: Monitoring the patient's response to medications is an important assessment activity for nurses, physicians, and pharmacists. In particular, monitoring the patient's response to the first dose of a new medication is essential to the safety of the patient because any adverse reactions, including serious ones, are more unpredictable if the medication has never been used before with the patient."

Effective July 1, 2010, TJC eliminated MM.07.01.01 EP 2 from the Hospital standards manual. This was done as part of a project to remove and/or revise standards that hospitals found to be of questionable value. In discussing this change, TJC indicated that the concept of assessment and reassessment is covered in PC.01.02.01: "The hospital assesses and reassesses its patients." However, this is a much broader standard which allows the hospital to define its process for assessment and reassessment. Thus, it is now up to the hospital to determine the most appropriate process for assessing a patient's response to medication.

Implication: Over the past several years, many psychiatric hospitals have received survey findings related to lack of a process for monitoring a patient's response to the first dose of a new medication. Often, surveyors were looking for a specific procedure in writing. In response, some hospitals developed a procedure for nurses to assess the patient's response within a specific timeframe and required specific documentation of that process. With the elimination of MM.07.01.01 EP 2, hospitals now have the latitude to define the best process for monitoring a patient's response to medications that have been administered.

Survey Readiness Strategy: Keep in mind that TJC always holds the organization to its own policy. So, if you developed a specific policy regarding monitoring first dose of a new medication, you should review that policy and determine what you think is best practice. If you retain a procedure specific to first dose monitoring, you will be held to that procedure during survey.

For details of this and other changes to the Hopsital standards, see the June 2010 issue of TJC Perspectives, page 1. These changes will be included in Update 2 to the manuals which will be mailed out by TJC in mid-October. Updates to the E-dition of the standards manual will be done in December 2010.